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SAN JOAQUIN E"virontnental Health Department TEMPORARY FOOD VENDOR'S APPLICATION AN food vendors (both for profit and non-profit) are required to return a sgned and completed c,)Cy of this checklsst to the festrval coordinator three(3)vmeks`prior to this event 1 1 Nam �1e of Event untl e-cr1T�1 _ Date(s) zy 2 The following is information about my organuabonlbusmess: Name of organrzabon/business:t7_�� l` noM Address q o 2 Q oa i lZ o c 9T372 I Phone ( Zo-, ) -0 53 Alternate ( ) 3 List food to be sold or given to the public Lfj G 4 1 am providing food that is NOT prepared at home: ❑Yes P No ' All food is prepared on-site or is from'approved commercial facilities:0 Yes❑ No Name of facility C�% U A t L e n _ phone: (Z°`t ) `�Y 3-a 33 3 Address of facility: '1 Q L C oad Cale- ,. Inc!), C4 5 U 7 1 5 1 am providing a booth with the following (to protect my urpackaged Cod and food-preparation areas from fliem. dust and the public) EfA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fty sc reerung, completely enclosing open food areas It wilt also have a smooth and cleanable floor (concrete. i asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. I ,gl Other(specify): r e 10 's A Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6. 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. ❑Other(specify) 7 Electnaty is provided for my booth's use: ❑Yes D6 No 8. 1 am providing an accurate probe thermometer fo measure the hot and cold holding of potentially hazardous foods during all Umes of booth operation: ❑Yes t4 No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135'F ❑ Camp stove ❑ Stemo&hotel trays ❑ Double steamer ❑ Steam table& lids ❑ Electric stove top ❑ Other (specify) Note: Examples of potentially hazardous food Include. m"W tamales, cooked beans, rice, vegetabies, potato salad, eggs, and dalry products. 1868 E Hazelton Avenue I Slockton. California 95205 1 T 209 468-3420 1 F 209 464 0138 sicelhd con) rHD 1"2 Page 7 of 11 TEMP EVENT APP 07/]It7