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From :*FAX NO. <br />the festival coordinator three (3) weeks prior to this <br />1. <br />2. <br />Address: <br />■/ <br />Phone: <br />3. <br />4. <br />5. <br />Q Other (specify): <br />6. <br />S. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />£3. Approved bottled water. <br />EH On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />Name of organization/business: 1 <br />13^0 A/, <br />( 701 ) ^3- 5000 <br />APR 1 0 2019 <br />Environmental Health Biejj^tfnent <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />gjA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />scrbening, 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 />4~ Date(s): Tuas A ~3c> ~- <br />0-27 4^7:20^ <br />1. Name of Event: „ <br />The following is information about my organization/business; <br />____________ . Alternate: (~ycr] ) <br />List food to be sold or given to the public.' r l-e./wjttA. ao/cT ; K,, <br />I am providing food that is NOT prepared at home: j^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: dV C(o - Phone: (70,1) STgoo <br />Address of facility: I(o 200 f\Jr y /O | , Ka/ t ^-5-470 ______________ <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 />Received TimeelApr, 9. iU2019;t<11: 01 PMaNo, 49085205 | T 209468-34201 F 209464-0138 | www.sjcehd.com <br />tHU 16-U2 Psge 7 of 11 TEMP EVENT APP <br />07/3/17 <br />■11. 24 2013 <br /> Other (specify):____________________ ______ <br />Electricity is provided for my booth’s use: Yes [94.No <br />1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: S 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 Stemo & hotel trays Jr f /1\ <br /> Double steamer Steam table & lids / / ’ <br /> Electric stove top Other (specify) <br />SAN JOAQUIN <br />?' Ote\-----COUNT Y------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1 event