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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />1 Name of Event1 <br />2 <br />Address <br />Phone <br />3. <br />5. <br />ther (specify) <br />6 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />_j Approved bottled water <br />9 <br />meats, tamales, cooked beans, rice. <br />T /O' <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 />7 <br />8 <br />i I A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh hv <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 /> Sterno & hotel trays <br /> Steam table & lids <br />J/4. Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 pnor to this event. <br />Date(s) <br />l On-site hose bib thai is connected to a potable water source. <br />K Other (specify) <br />Electricity is provided foi my booth's use 0^Yes O No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentiallv hazardous <br />foods during all times of booth operation £3 Yes No <br />I am providing the following hot temperature control for the hot holding of ail potentially hazardous foods above <br />135‘F <br /> Camp stove <br /> Double steamer <br /> E lectnc stove top <br />The following is information about my organizatiorvbusiness <br />Name of organization.'busmess < <br />(Alternate: <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home Yes No <br />All food is prepared on-site or is from approved commercial facilities. J^Yes No <br />Name of facility l Phone: f /J <br />Address of facility S' ^h/■ Icir/PCk. <br />I am providing a booth with the following: (KTprotect my unpackaged food and food-preparation areas from flies <br />dust and the public)