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�',.,li�:'. ;" `,.«.rC". -.7. 7 ., ��"L2n"R"� :�X„ �.--,1:.. N Yam„ 'L��4�F-P--'fT^[{F .k...T'Ef.,,,1��.I,i dri.._ ✓! 1T'W 'rtS n;�Y SA loJOAQUIN Environmental Health Department 1 ---COUNTY_.- TEMPORARY FOOD VENDOR'S APPLICATION AR food vendors(both for profit and nor profit)are requirod to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event- 1. 1.Name of Event: f t�� y s _ ❑ale(s):�I�..-. 2 The€ol}owing is information about my orrdanizabonlbusiness: Name of orgla�nbahorub/uysine.,s: Address: Phone: {�� } ;1 L� Alternate:( )_.__�__------.---_.-.-. 3. List food to be sold or given to the public: 4. 1 am providing food that is NOT prepared at home.: Yes n No Atl food is prepared on-site ar is from approved commercial facilities:'V�--yes❑No Name offaality: Phone: Address of facility 5. 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 ceihng constructed of rather wood,canvas, plastic,similar material and tine mph fly screening, completefy enclosing Open food areas, It wit} alsn have a smooth and deanable floor (concrete, asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Y; Pother(specify), Note: The only operations not requln d to provide enclosed booths are those which sell beverage_ from approved dispensers,or prepackaged foods from approved sources- 6. Approved water for drinking,utonsii and hand washing will be provided in my booth by the following met}tods: PApproved bottled water- Wbn,.6ge hose bib that is connected to a potable water source. . Other(specify): -- )Ek c&icity is provided for my booth's use:0 Ye No $. 1 am providing an acxurate probe thermoMeter to measure the hot and cold holding of potentially hazardous foods during all times of booth operaticfes 0 No 9. 1 arm providing the foUawing hot ternpetature oontrol for the pot holding of all potentlally hazardous[nods above Carrip stave ❑Sterna&hotel trays [l Double steamer ❑Slearn table&lids F,.. ..ll fjedric stave top. El.Other(specify) a Not, . Examples of potenaally hazardous food Include. meats, tamales, cooked buns, rice, vegetables,potato salad,eggs,and dalry products, JBW E.HaieHsst't Aven4e I. Acton,.CaWofnia S52051 F 2.09 464-01.35 1 www.sJcehd.cofrt TE1� a t.t Eve P