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TEMPORARY FOOD VENDOR’S APPLICATION <br />Patefs):1. Name of Event V\VVy A S'1 <br />2 <br />Name of organization/busmess ( C C\ \ <br />Address <br />Alternate. (Phone <br />3. <br />4 <br />.. <br />5 <br />Lj Other (specify) <br />those which sell beverages from <br />Note <br />Approved6. <br />connected to a potable water source <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />Note <br />7 <br />9 <br />i required to provide enclosed booths are <br />prepackaged foods from approved sources <br />nd hand washing will be provided m my booth by the following methods <br />C'2 , ■ v <br />List food to be sold or given to the public: V'\< i.,<)_ <br />#41^ <br />Environmental Health Department <br />The following is information about my organization/business: <br />. \ TA vy\; <br />12 <br />SAN JOAQUIN <br />water for drinking utensil a <br />•' ; usptS Yes L .1 No <br />accurate probe thermometer to measure <br />folloXrh^S^^ hOt hOld,n9 °f a" P°ten"a,ly hazardous foods above <br /> Sterno & hotel trays <br />O Steam table & lids <br />Other (specify) CO \. 5 <br />hazardous food include, <br />iggs, and dairy products. <br />The only operations not <br />approved dispensers, or, <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />'A Ake <br />I am providing food that is NOT prepared at home: No <br />All food is prepared on-site or is from approved commercial facilities: & Yes L! No <br />Name of facility ..............1.....................T -.-..............................- Phone (--------j------------------------------------- <br />Address of facility ............ 2—.... —i------------------------ — ------~~ <br />I am providing a booth with the following, (to protect my unpackaged food and iood-preparation areas from flies, <br />dust and the public) <br />f".^Af)Pr,wed bottled water <br />On-site hose bib that is <br />I I Other (specify) -- ------- <br />Electricity is provided for my boofo s <br />I am providing an <.......- <br />foods during all times <br />I am providing the I . <br />135‘ F <br />O Camp stove <br />I j Double steamer <br />r j Electric stove top <br />Examples of <br />vegetables, potato salad, e< <br />booth witf> walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />areas from the public. <br />).....-............LrC.. <br />■' v ' i <br />\ roc mfo, .E.'Y.'Vx-jL-..