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TEMPORARY FOOD VENDOR’S APPLICATION Date(s): June 15-1^ 201^1. Name of Event:1. 2. Address: ) (916)803-4851 Alternate: () (Phone: Please see attached menuList food to be sold or given to the public:3. 4. 5. 6. On-site hose bib that is connected to a potable water source. 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPago 7 of 11EHD 16-02 08/01/16 Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Name of organization/business: 9700 Fair Oaks Blvd, Suite J, Fair Oaks CA 95268 Other (specify): __ Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: 0 Approved bottled water. Other (specify):_— Electricity is provided for my booth’s use: R] Yes No ;ter to measure the hot and cold holding of potentially hazardous ] Yes No The following is information about my organization/business: Midway of Fun Candy LAxxd I am providing food that is NOT prepared at home: 0 Yes No All food is prepared on-site or is from approved commercial facilities: (3 Yes No Name of facility: N/A Phone: (-------)------------------------------------ Address of facility:------------------------------------------- --------------------------------------------------------------------------------- I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) SA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. I am providing an accurate probe thermomet' foods during all times of booth operation: -Q I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: , Please see attached menu Camp stove Sterno & hotel trays Double steamer Steam table & lids Electric stove top Other (specify) All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. San Joaquin County Fair