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Environment ealth Department <br />2. <br />3.) <br />4. <br />1Phone: (. <br />5. <br />6. <br />meats, tamales, cooked beans, d <br />Note:pc^rto salad, eggs, and dairy products. <br />7. <br />3. <br />e-^v <=, <br /> Alternate: <br />Date(s): -• <br />■ Haze^A^i S»cMOR.Catfomia95205| T 209 4^34201 F 2094644)138 I <br />fc PeMiTaf^ <br />SAN JOAOU'1' <br />__county---- <br />' ■ ■ > ■ Grcotnesf growi h> , <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />1. 1. Name of Event: OO r> 0-00-2 <br />The following is information about my organization/buslness: <br />Name of organization/business: <br />Address: cAol< tic STTre. <br />Phone: ( g>~[ <br /> List food to be sold or given to the public: _£?toyXK5> <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: ____ _______Phone: [------ <br />l^^iSin^Xoth with thefoiiwringT(to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />0 A booth «th wall, and oaiW a SSJbla <br />^aTdeSX?andnX'S S aw aoeaplabla) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify): _—-------------------------------------------- --— --------------------------------- <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />O Onsite hose bib that is connected to a potable water source. <br /> l^n’^idirS^80^^Probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />/ am providing trie following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />[J Camp stove Stemo & hotel trays <br />[J Double steamer Steam table & lids <br />[J Electric stove top D Other (specify) <br />‘ : Examples of potentially hazardous food include: <br />m. <br />) 55 4. - tSA