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FROM •:FAX NO. <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />- <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APP <br />7. <br />8. <br />SANJOAOUIN <br />.....-COUN"Y- <br />^ci rYj_______ <br />mn p 4^.0^a- > Cm <br />££] On-site hose bib that is connected to a potable water source. <br /> Other (specify);__________________ __—------■.------------------------------------------------------------------------------ <br />Electricity is provided for my booth’s use: Si Yes 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 Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove Stemo & hotel trays <br />Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Name of organization/business: ^^-^0 <br />Address: \ A < <br />ms ft i= l-403-aitr.in ia i s;tr,r.ktr>n California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Received Time May. 2. 2019 3:21 PM No. 4977 pa^Tom tempeveni <br />07/3/17 <br />All food vendors (both for profit and non-profit) are i ’ ' <br />the festival coordinator three (3) weeks prior t" this event <br />I.Name of Event: (0a- ^V\C>ir~l6.^pate(s <br />L' / <br />The following is information about my organization/business: <br />Phone: ~ Alternate: (2<A ) 1(20 4 <br />List food to be sold or given to the oubliCi'TT1 Tip , BaC-(XT \6t43cJqS > Ct loS, <br />LVPr-MrS- <br />I am providing food that is NQT prepared at home: Yes <br />All food is prepared on-site or is from approved commercial facilities: "H Yes No <br />Name of facility: d MS Phone: ('//f] ) ~<4 §4 <br />Address of facility: /T A 1 A i 04V (A'S?>4>C^1 <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. <br />t^Other (specify): _____.._____■■ ■___________________________________ <br />Note: The only operations , not required to provide^encfosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />S Approved bottled water. A .- <br />49. 16 2013 2:18PM P2