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SAN JOAQUIN Environmental Health Department TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. rr�� �a Date(s) 3.d�•�� 1. 1.Name of Event: •_.. � �_ ��,}�Z[• ,'1 2 The following is information about my organizationlbusiness: Name of organizationlbusiness. �-- `rtlt'S �)naS Address: .................... LJhhIJ'd �_ Phone: crl N Alternate: ( ) 3. List food to be sold or given to the public: -- -- - e. c ��-� o..,., ., • �a S b� � �. d . ,„ -J�--6e s,gri 11 C1hee u on 4. 1 am providing food that is NOT prepared at home: [Z Yes❑ No � g All food is prepared on-site or is from approved commercial facilities: DO Yes❑ No Name of facility: Phone: 1 Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ❑ Other(specify): f ��- Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. ❑ On-site hose bib that is connected to a potable water source. ❑ Other(specify) __ Q ' ` �'GAL -- 7. Electricity is provided for my booth's use: [X Yes❑ No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: M Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑ camp stove ❑ Sterno& hotel trays ❑ Double steamer ❑ Steam table&lids ❑ Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products. 1668 E Hazelton 5tccki,:sq California co5205 I T 209 463-3420 1 F 209 461-0138 1 I-miv11rl.sigoV of-ci.rhd FHA 16.02 Page 7 orf 1 TEMP EVENT APP W2912023