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AW <br /> SAN JOAQUIN C4 <br /> _ 1pi ENVIORMEN'TAL HEALT UDEPARTMENT <br /> 1848 East Hazdtou Avenue,Stodktoa,California 93M <br /> ;. Bit (209)468-3420 <br /> , •,a ,, .K ,-,- - <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vers(both for profit and rte-profit)are required to return a signed and completed copy of this <br /> checkli"the festival coordinator three(3)weeks prior to this event. <br /> 1. Name of Event:`yT,�lr i �� c Y /�__-.- Date(s): ��" 1 <br /> 2. The following is information about my organizatio Annine s: J <br /> Name of tion/business: :�a <br /> Address: 0_y, 16t5 <br /> Phone: 2,6 2 2 — Altafnate: ge I fs-3-- ,F4 76 <br /> 3. List food to be sold or given to the public: 45 <br /> 4. I am providing food that is NOT prepared at home: [0q Yes [ j No <br /> All food is prepared on-site or is from Mxovpd commercial facilities: [AYes [ ]No <br /> Name of fscil4: Phone: !-�j •--5�� <br /> Address of facility: 19 7S z <br /> am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br /> flies,dust and the public) <br /> A booth with walls and ceiling consbucted ofvither wood,canvas,plastic,similar material and fine <br /> By wreentn&completely enclosing open food areas. It will also have a smooth and cleanable floor <br /> (concrete,asphalt,clean tarps and smooth wood are acceptable)and constructed to separate food and food <br /> preparation areas from the public. <br /> [ ] Other( fy)� <br /> Notre. The only operations not required to pram►ide enclosed booths.are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> b. Approved water for drinldng,utensil and hand washing will be provided in my booth by the following <br /> methods: <br /> Approved bottled water. <br /> On-site hose bib that is connected—to a potable ware source. <br /> [ j Otter(may): <br /> 7. Electricity is provided for my booth's use: 1<1 Yes [ ]No <br /> 8. I am providing an accurate probe dwrmometer to the hot and cold holding of potentially hazardous <br /> foods during all time of booth operation. [?kyes [ j No <br /> 9. I am providing the following toot te;nperatu re crnmt for the-hot holding of all poten Wffiy hazardous foods <br /> above 135 degrees Fahrenheit: <br /> Camp Stove [ Double steer [ ]Electric stove tog <br /> [ ] Stesmo&hotel trays [ 1 Steam table&lids [ ]Other(specify): <br /> Notes Exampks of potentially harm ous food include:meats,tamales,cooked beans,rice vegetables, <br />