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* <br />Environmental Health Department <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />VJ Camp stove <br />EJ Double steamer <br />I I Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />- iI SANjJOAOUIN <br />^COUNTY— <br />G'eotness grovv5 hc!X <br />A|| TEMPORARY FOOD VENDOR’S APPLICATION <br />Jhe festi^0^^ for Prafit and <br />1. <br />Id A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />areas fromthepubhc3^ Sm°Oth WO°d acceptable) and constructed to separate food and food preparation <br />O Other (specify): <br />Note: The only operations not required to provide enclosed booths are those which sell beveraoes 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 />'QzApproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />El Other (specify): <br />Electricity is provided for my booth’s use: Q'Ves No ~ -------- - ------ <br />1 “and cold holdin9 <br />1 ai35T'din9 016 fOilOWin9 hOt teroperotnro control for the hot holding of all potentially hazardous foods above <br />Q^temo & hotel trays <br />O Steam table & lids <br />O Other (specify) <br />— ■'al coordinator toreeTs) week°n pro^ reclu'red to return a signed and completed copy of this checklist to <br />1 Name°'EM"t---------______________________________________■ Datefs): <br />lowing is information about my organization/business. <br />Name of organization/business: fCOVS'tie, <br />Address; _______________________________________________________________________________ <br />_____-________________ Alternate: ( Ifo5') Z9 S <7______________ <br />List food to be sold or given to the public:r r; /jz t/ >4A/ £ <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: Hfves No <br />Name of facility-. />££ _______________phone: <br />Address of facility: 2^0^ r ISo S' <br />1 ^sTand the puS0^ followin9: ^to Protect my unpackaged food and food-preparation areas from flies.