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HeaiSth DepartmentEnviranmu <br />All tooa vendors (»oih it. piuiii aiid <br />1 <br />ft J <2 ; 6 5 <br />Address: <br />Phone: <br />3. <br />5. <br />, j Other (specify): <br />6. <br />9. <br />7 <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />3r to measure the hot and cold holding of potentially hazardous <br />Yes No <br />H i . x _ tu — — — I.. r>r>‘ rr^ni iirr-.rj In nrrs\/'Ho c.r.r'.r'.caH Ora JKf'CO wK!r*h VlOX-PraHP1. frC' ■ : <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />5*1 On-site hose bib that is connected to a potable water source <br /> Other (specify); <br />Electricity is provided for my booth's use; Yes No <br />i am providing an accurate probe thermor <br />foods during all times of booth operation: <br />5 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />_J35°F: <br />_; Camp stovp I I Stamn A hntp: tray? <br />Double steamer J^fSteam table & lids <br /> Electric stove top Other (specify) <br />1868 E. Hazelton Avenue | StocMon. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD1M12 Page7oM1 TEMP EVENT APP <br />2 A booth with wails and ceiling constructed of eitner 'vvood, canvas, plasto, stmiiu. matu..^. ■ - ' ■ j <br />screening, completely enclosing open food areas. It will also have a smooth and cleanab.e 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 />All food vendors (Ooi.h fc. piofii and noi< proht) arc required ic ,! ’ <br />the festival coordinator three (3) weeks prior to this event <br />1. Name of Event: O A C \ -------- <br />-e following is information about my organizatlon/business: <br />\AArc / <br />-- t :ni A: if-ineSS' v • 'J-A -.t-. .. _ . <br /> <br />)j=d___ <br />List food to be sold or given to the public: <br />meats, tamales, cooked beans, rice, <br />■ vSANJOAO^.N <br />H -—-COUNTY— <br />G- ectne^'- gro".'S here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />ar.r; nempiutud <br /> Date(s): . .• • [ r^Ol <br />Cl 11 Ml I' I <br /> <br /> \/\\> f------—---------------- <br /> C4 0 S 1 Alternate: (2 1—------------ <br /> ----------------------- <br />u—- M <»i«AV »><■>••»-.< I • »«•. • .... <br />................ » V’. < *1 f tITit IMV I pc-MCI* MO O • v/* • K' \ • J • <br />A' food is prepared on-site or is from approved commercial facilities- Yes G No <br />Name of facility. lAYJ^ j ____________Phone: p d I —V ------ ----------- <br />Address of facility: l AuC-'1 iAv< 'I4'\1r A2 J------------------------— -----—----- <br />j am providing a booth with the following: (to protect my unpackaged food and food preparation areas from .ties, <br />dust and the public)