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■» <br />Environmental Health Department <br />2. <br />Name of organization/business: <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />O Electric stove top <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />I am | ................ <br />135°F: <br /> Camp stove <br />EZ] Double steamer <br />j~~| 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />O Other (specify): r <br />Date(s): <br />Z-Z <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): _______ <br />Electricity is provided for my booth's use: S’es O No <br />I am providing an accurate probe thermometer>io measure <br />es No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods; <br />[jJ'Xpproved bottled water. <br />The following is information about my organization/business: <br />.C.-m <br />_______ AHemate: ( <br />11 < <br />„ the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: [y/Yes Q No <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />Q'Stemo & hotel trays <br />Q Steam table & lids <br />Oo*j) 2-oW-^lg- <br />List food to be sold or given to the public. <br />L————— <br />: ? Q ^7 7 Z-------- <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 />SAN JOAOUIN <br />COUNTY <br />' Greatness grows here <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. E ' / <br /> I.Name of Event P■ <br />I am providing food that is NOT prepared at home: O Yes O No <br />All food is prepared on-site or is from approved commercial facilities: 0Yes O No <br />Name of facility: ,^^7/ •4- Phone: (^°5) 2-0.7—----------------- <br />Address of facility. 731^ M _> 7~ C1-/___2-------------------—— <br />I am providing a booth with the following: (to protect my uhpackaged food andTood-preparation areas from flies, <br />dust and the public) <br />O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.