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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.Name of Event: JWLGRAP^FESTiyAL_____Dato(s)SEPTEMBER 14-17,20231. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods:6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />I kr/Hlnn Avnmin I Skvklnn P.nlifnmin I T 70Q 4Gh-'l42n I I' 9(1<) 4K4-ni3K I miw ciirinw niTi/nhd <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />7. <br />8. <br />Q A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from tho public. <br />Other (specify);__________ <br />SANJOAQUIN <br />cot J N I V <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />List food to be sold or given to the public:Alternate: ( ) <br /> <br />I am providing food that is NOT prepared at home: p^Yes Q No <br />All food is prepared on-site or is from approved commercial facilities: Q Yes No <br />Name of facility: l/SS)Phone: __ <br />Address of facility: V7 j <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br /> On-site hose bib that is connected to a potable water source. <br />M Other (specify): IMS tMrt b <br />Electricity is provided for my booth's use: £3 Yes Fl No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No A/// <br />I am providing the following hot temperature control for tho hot holding of all potentially hazardous foods above <br />nST: , ' <br /> Camp stove Q Sterno & hotel trays /y/r <br />[Z] Double steamer ( | Stoam table & lids <br /> Electric stove top Other (specify) <br />The following is information about my organization/business: Name of organizalion/business: <br />Address: USA-, pO 6o)C ^33, ^5757 <br />(7/^i 33^9