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SAN JOAP'iin Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />& <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />fa Approved bottled water. <br />Noto: The only operations not required to provide enclosed booths are those which seH beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />[ )_______ <br />Datefs):"^ 7 <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />p-' <br /> Other (specify):_____________________ <br />Electricity is provided for my booth's use: K<Yes 0 No <br />I am providing an accurate probe thermorneter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: H Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135*F: <br /> Camp stove <br /> Double steamer <br />Electric stove top <br />Al food vendors (both for profit and non-profit) arc required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to tho event. <br />1. Name of Event. 79(\ <br />The following is information about my organization/business: <br />Name of organization/business- hMm <br />Address. V\^ \_MVj - <br />Phone: (^\) 51^9 *5^?^ Alternate: ( <br />List food to be sold or given to the public: F ^(3 ' W\W \ 1 <br />I am providing food that is NOT prepared at home: (X Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes fS No <br />Name of facility.Phone ( ) <br />Address of facility: <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 />^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 the public.