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J i Environmental Health Department 1. 2. r A f5 IAddress: Phone: 3.f 4. 5. 6. 9. Hazelton Avenue | A 7. 8. 135"F: Camp stove Double steamer Electric stove top Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. SAN JOAQUIN ------COUNTY Greatness grows here. TEMPORARY FOOD VENDOR’S APPLICATION Alternate: ( ) 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. I.Name of Event: FEST Other (specify):____________________________________________ Electricity is provided for my booth's use: Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above O Stemo & hotel trays Steam table & lids pother (specify) ^Jt) meats, tamales, cooked beans, rice, 4>'- i0ov.o<B/ehd a Date(s): |Q^|7J)7^ Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. OCkton. California 05205 | T 209 488-3420 | F 209 484-0138 | www^ The following is information about my organization/business: Name of organization/business: [qC&S (^) List food to be sold or given to the public: A f f dS> I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: &,Yes No Name of facility: DOVYl l Q l^fr rVUGrloXVxo Phone: (IxPl) Address of facility: I 7_l\ > S t I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A 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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify): UI Note: The only operations not required to provide endosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources.