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FAX NO.FROM : • <br />RECEIVED <br /> Am i n 2019 <br />/ <br />F <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />Phone:) <br />3. <br />4. <br />5. <br />6. <br />8. <br />9 <br />[* j <br />vegetables, potato salad, eggs, and dairv nroducts. <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVIOES <br />D Stemo & hotel trays <br /> Steam table & lids <br /> Other (specrty) <br />SAN JOAQUIN <br />COU Ni T y -... <br />O Yes No 7 “ . ■ • <br />foods during all times and coW bokfing of potentially hazardous <br />lentially hazardous foods above <br />meats, tanafes, cooked beans, rio. <br />All food vendors (troth for pruft 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 I . r > <br /> paonTDojn ym n w I so- Bizi/fl <br />The following is information about my organizatjon/busfoess: <br />Name of organizatron/busioess: Lf/mh fex <br />t5ft>-5^M262____ _ Alternate: ( <br />List food to be sold or giveo to the public: <br />I am providing food that is NOT prepared at home: Q No <br />AM food is prepared on-site or is from approved commercial fedlities: O Yes Q No <br />Name of facility: » I y h _______Phone: ( ) _ <br />Address of fardity: l\J / _ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />^Ta booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />!nctosin9 °Pen food arcas- ft wffl also have a smooth and cleanable floor (concrete <br />S^to^Te^Wic SmOO{h WTOd and ^tructed to separate food and food preparation <br />^3 Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided m my booth by the following methods: <br />'EbApproved bottled water. <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: [J Yes H No -----------~---- <br />1 i?’.aocurate P™**2 thermometer to---- 2 - ■ ■ <br />a1l5t^Vtdln9 foBowinS hot temperature control for the hot holding of all pot< <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <br />Note: Examples of potentiaHy hazardous food include: <br />il. 24 2013 9:57PM P2