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SAN JOAOUld <br />Date(s) 1. <br />2 <br />Address <br />Phone <br />3. <br />4 <br />5. <br />6. <br />fj Approved bottled water. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice. <br />F 2t T=UP E’XT A.pr <br />9/3/2021.6: <br />7. <br />8. <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1868 E Hszel’.on A/ente <br />EliD 16 02 <br />06; rang <br />' ' 7 - <br />Page 7 of 11 <br />Environmental rieaith Departrr.srit <br />■ <br />[""I On site hose bib that is connected to a potable water source <br />[/Other (specify)^ l\0 wW U fct AU fM dtri / MA <br />Electricity is provided for my booth s use: [2] Yes 3^No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F; <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 event1 Name of Event cP A StzxXApn Date(s) ' t O ( 2-( <br />The following is information about my organization/business <br />Mame o< Bi T<*S t- ---------------------------- <br />(01^ C/v <br />0.0^> Alternate: <br />List food to be sold or given to the public: VYXcX , lYK&S <br />I am providing food that is NOT prepared at home I 1 Yes f^No <br />Ail food is prepared on-site or is from approved commercial facilities: Q Yes L^jNo <br /> Name of facility Phone: £ <br />Address of facility:____________________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from les <br />dust and the public) <br />[ i A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable fioor (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />GZother (specify). i0 )C I 0 _ ___ <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: