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<br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />I www.sjgov.org/ehd <br />TEMP EVENT APP <br />7. <br />8. <br />SAN JOAQUIN <br />~COUNTy__ <br />I??-* J <br /> ■J. <br />!*' J <br />J <br />r <br />All food vendors (both for profit and r.„.. „, <br />the festival coordinator three (3) weeks prior to this <br />1.Date(s): 7Z <br />* ' 4 <br />*•HI <br />w <br />EX’Hi,Ze"“ A"n“e ' aO*°"'Oa,ifo™952^?T 209 468-34201 F 209 464-0138 <br />Iw- <br />•Ji* - <br />■-'Vi'- <br />non-profit) are required to return a signed and completed copy of this checklist to <br />, L „‘/j event. <br />1 .Name of Event:^0^0^ U(\/y <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: AtTt C Oft, ^S20LP_______________________ <br />( IA OS' Alternate: (2#f ) <br />List food to be sold or given to the publicffi^-IR-/"7 <64 B P P k/IS' t <br />I am providing food that is NOT prepared at homeJ^J Yes ^No^^^^ <br />All food is prepared on-site or is from approved commercial facilities: Yes [Xno <br />Name of facility: phone: ( ) <br />Address of facility: <br />' Vdth9 3 bM°\h With the followin9: (to Protect my unpackaged food and food-preparation areas from flies <br />uusi ano ine puolic) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete7 <br />areas^oXe pX 8 316 aCCeptab'e) and constructed to separate food and food preparation <br />fcpec«y): - ffl C-tPO p < CT./ Uc4 V < (Jft/lSVtfLZ ftf Iv,), / <br />Note: The only operations not required to provide enclosed booths are those which sell beveraqes from <br />approved dispensers, or prepackaged foods from approved sources. 9 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />/_L<Approved bottled water. <br />HlJiPn-site hose bib that is connected to a potable water source. <br />^Other (specify): <br />Electricity is provided for my booth's use: Yes VJ^No --------------~ <br />ZdTJX^IiVmTsXoX'perXni"□ ySnT6 b0'^9 °f ha2ardous <br />XsT07'6'09 ’he f°"0Win9 h0‘ternperature control for the hot holding of all potentially hazardous foods above <br />®amPSt°Ve □ Sterno & hotel trays <br />J ^Double steamer Steam table & lids <br />Jtoctric stove top Other (specify) <br />Note: Examples of potentially hazardous food include- <br />vegetables, potato salad, eggs, and dairy products. <br />••7