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SAN JOAQUIN Environ ental Health Depafiment <br /> —C O U i 4 T Y----- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both jar prom and non-profit)are required to return a sig;ied and comp3eted copy of this checUlsl to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 7. 1-Name of Event I ' � 0 <br /> 2 The following is information about my organ"rcatsonlbusiness: <br /> Name of organ"rlabonfousiness <br /> ,address: <br /> PhonE; <br /> Altem ltl e:( ) <br /> 3. list food to be sold cr given to the public- 7 <br /> 4. f am providing food that is NOT preparedat hgrnev j_No C GL VGLt7ZQ r/ Vu <br /> All food is prepared on-sit or is from approved commercial facitrkies if Yes Nfl7 <br /> Name offacTdy Phone:( 1 <br /> Address of facility, j <br /> 5, 1 am providing a booth vrath the�Jowrn_gq-(to protect my unpackaged food and food preparation areas from flies, <br /> dust and the public) <br /> A booth with yr ells and ceiling constructed of Either wood,canvas pfast3c,similar mateiial and fine mesh fay <br /> Wing, completeiy enclosing opera food areas" It wifl also have 19 smooth and cleanable floor (concrete, <br /> asphalt, dean carps and smooth wood.are acceptable)and constxrcted to separate food and food preparation <br /> areas from the public, <br /> ❑Other(specify): <br /> Note: The only operations not required to provide enclosed booth ,are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved so ices. <br /> 5, Approved ureter for drinking,utensil and hand washing viall be provided in my booth by the follavrvirlo methods: <br /> Approved bottled water- <br /> 0 On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7" ElecMcity is provided for my booth's use: Yes E]No <br /> 8" 1 am prflAcling an acctarate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during 231 tunes of booth operation:'Ryes❑No <br /> 9. 1 am providing the following hot temperature control for the bot holding�012B pctentially hazardous foods above <br /> 135T. <br /> 0 Camp stave }]Stemo&motel trays <br /> ❑Double steamer ❑Steam table&lids <br /> [�Electric stove lop AOtl er{specify) <br /> l Cab, dvu <br /> Note: Examples of potentially hazardous food inclll� mats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products_ !I <br /> '1$68 1 "t lazelfon Avenue J Sfodcton,California 9520k5 1 T 239468 3420 j 217'?4Eg-p338 1 v,urvr-sjcehd"rom <br /> Io zsaz <br /> 07PJi7 Page7d�� <br /> II TEMP J_*rrrr spa <br />