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Environmental Health Department <br />G <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event1. <br />2. <br />Cr) <br />3. <br />4. <br />5. <br />O Other (specify) . <br />6. <br />I <br />9 <br />meats, tamales, cooked beans, rice, <br />*>**/<« <br />Jiiw. <br />7. <br />8. <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />COUNTY <br />Date(s): <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: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during alt times of booth operation: Yes No <br />1 ,he f0,towin9 ho1 temperature control for the hot holding of all potentially hazardous foods above <br />ETstemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />ifl r <br />. cjj-----ftWlC---------------- <br />Alternate: ( ft? ) ---------------- ------ <br /> <br /><5^3 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this ch <br />the festival coordinator three (3) weeks prior to this event. <br /> fWflA DAtslPli) 2-o Pvg/dft fVTA <br />Ihe following is information about my organization/business: <br />Name of organization/business: KCiP LLC <br />Address: <br />Phone: ( ylO ) 1624 <br />List food to be sold or given to the public: fi i (XYlS j L <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: £3 Yes No <br />Name of facility: R*' (3 L-Zr-A ~ — Phone: (A-f,^) 6'?'^—1----------------- <br />Address of fadlitv: 'itlML-C’l Vlfrf; M ---------------------- -- <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 />Ej-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 cteanable floor (concrete, <br />asphalt dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.