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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event: <br />2 <br />lAName of organization/business. <br />Address: <br />) Phone: <br />List food to be sold or given to the public: 3 <br />4. <br />5. <br />O Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:5. <br />F~l Approved bottled water. <br />O On-site hose bib that is connected to a potable water source. <br />J. <br />r- <br /> Stemo & 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 />7 <br />3. <br />F 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 cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />■4--------------- <br />O 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 all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />.0 c). > <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: f Phone: ( ) <br />Address of facility: AAvC \ _________________________ <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 />meats, tamales, cooked beans, rice, <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist tc <br />the festival coordinator three (3) weeks prior to this event. /) / / <br /> <br /> 7-^/1^ <br />The following is information about my organization/business. <br />ZlV ' ( <br />G(xz\ u ________________________ <br />\ j ' <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 />C <br />7— <br />Alternate: (