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A <br /> SANAMUM Environmental Wealth De`par f ment <br /> r�.Sr COUNTY <br /> - <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> ill rood vendors (Wh for profit ana nart-prdiil)are required to return a signed and completed espy of this checklisi to <br /> the feslival coordinator three 131 weeks prig ID this everil_ <br /> 1_ `.haute of Eveni t r0La D ate is}: <br /> •3 . <br /> 1_ The iollowing is iniormati on about my orgarazatranbusiness. <br /> Name of organizawn,business: <br /> Address: I SFAQ C nered Bndge 11V" <br /> Phone: I Alternate <br /> : j <br /> 3_ List f:rid to be sold or given to the puvc, aye <br /> 4- 1 am provotrrq food that is NOT preparea at hone: N1 Yes ❑ No <br /> .All food is prepared on-site or is from a;rproved commercial facilities. ❑ Yes ❑No <br /> Name of tacat8y: Phone. r 1 <br /> .Address of tacitly: <br /> 5_ 1 am pro%,,dtng a Moth with the following: (to protect my urtpackagec food and food-preparation areas from ties. <br /> dust and the pub[►c i <br /> booth with walls ana ceiling constructed of erher wood, canvas. rlaslic. similar material ana fine mesh fly, <br /> screening. completery enclosing open food areas. !t will also haoe a smootri and cleanable floor focincrete. <br /> asphalt. clean tarps and srrKa€'oth wooa .are acceptable) and const►uctec to separate food anc food prenaration <br /> areas fron the public. <br /> ❑Other(specifyi- <br /> Note: The only operatons not required to provv.1e enclosed booths are trrrse which sell beverales from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> E r".x1roved water for drinking. utensil arrd hard wasrwrrq will be provided in my booth by the following metto:ls. <br /> ❑.Approved bottled water.. <br /> ❑On-site worse bib that is conneciea tc a ;:olaUe water source. <br /> ❑Other <br /> of <br /> 1. Electricity is provided for my booth's use: 0 Yea o <br /> 8- 1 am proving an accurale probe thermometer td easure the not ana cod ho4dirg of potentially hazardous <br /> foods during all times of booth orberation:N les ❑ No <br /> 9_ 1 am promchng the folowing hot lemperature ctntrol for the hot h•oNli to of all potentially hazardous foods arrive, <br /> 135`F. <br /> ®camp stove ❑Memo& hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑ E lectric sio%*top ❑Orher I specify, <br /> Note: Examples of potentially hazardous food anclude., meats. tamafes. cooked beans, rive, <br /> vegetables.potato salad,eggs,and dairy product& <br /> 1868 E. Hazelton Avenue I Stactftm,California 952M I T 209 468-3420 1 F 209 4"0138 1 www.sjgoy.org.-'ehd <br /> Era 16412 Pa"7 of 11 TEBV IEVIB4T►PP <br /> 0WUllm <br />