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I <br /> r: ,lN SANsJOAQUIN <br /> . Envtrc:rtrn�r+ �1 Hea�ti� Ut?p��•t����'ils ` <br /> ---COUNTY <br /> Greatness rgruws here. <br /> TEMPORARY FOOD VENDOR`S APPLICATION <br /> An food vendors(both for profit and lion-profit) are required to return a signed and cornptytad copy of this checklis'lc <br /> the festival coordinator three(3)weeks prior to ibis even 1. <br /> 1. 1.Name ofEvent Red, White & Brew J'f • : <<ui F„• ii Dato(s): <br /> 2. The following Is Information about my orgartizstlonlbuslness: <br /> Rhome c &F-trr., <br /> Name of organizatloNbusiness: - - -- - - - <br /> Address: 3105 Morada Ct Moe tt J-r (7- -6:35c: <br /> Phone: ( 209 ) 9224475 Alternate: ( ) <br /> r.c f',�c]illc � ':i I.', •��rx;.r: L.h.?cSf. Stl'.9� �:� ': -, <br /> 3. List food to be sold or given to the public; ": �•� <br /> 4. 1 am providing food that Is NOT prepared at home:2 Yes ❑ No <br /> All food Is prepared on-site or Is from approved commercial facilities: ®Yes[]No <br /> Name of facility: _ r ° Phone; -- <br /> Address of facility, <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food preparation areas from files <br /> dust and the public) <br /> Q A booth with wails and calling constructed of either wood., canvas, plastic, similar inateriai and fine mesn fly <br /> screening, comptoteiy enclosing open food areas. it will also havo a smooth and cleanable floor (concrota. <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparallor <br /> areas from the public. <br /> ❑Other(specify): <br /> Notts_ The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged fouls from approved sources. <br /> B. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> a <br /> ®Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source, <br /> ❑Other(specify): <br /> 7. Electricity Is provided for my booth's use: Yes No <br /> 8, 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operaticn: (2 Yes ❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods abovo <br /> 135°F: <br /> ❑ Camp stove ❑Sterno&hotel trays <br /> ❑ Double steamer ©Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Nola: Examplos of potentially hazardous food Include: meats, tamales, cooked boars, rice, <br /> vrigotablos, potato salad,eggs,and dairy products. <br /> �.,,•.:1ts,r, rtY'r H.,�r 1 ;;tpr_ktC,r 1, c;tillfornla 9FJ205 I T 209 4LI8-34 (' i F J04 46�1-r1'13n 1 wLvw.S1QUr.ulylor}�i <br /> TEA4F°HVC,OT AA!• <br />