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SAN JOAQUIN Environmental Health Department <br /> —C d U Ih•l T Y-- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-groq are required to return a s3gnl ed and completed cGpy of this chec Smi to <br /> the festival coordinator three(3)weeks prior to this event <br /> 1_ 1.Name of Event: L <br /> s � I ❑ate{s):� J�� <br /> 2. The following is information about my organization/business. <br /> ]Name of organkationlbusmess <br /> ,address: <br /> phone: ( ) Alternalte:{ ) <br /> 3, list food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home- es❑No <br /> All food is prepared or is from approved commercial faahes. Yes❑No <br /> Name of facirrtyr phone: <br /> Address of fac'MV- <br /> �. 1 am providing a booth with the foJowing:(to protect M. unpackaged f od and food-,reparatior;areas from fi"tes, <br /> dust and the public) <br /> A:booth with walls and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly <br /> s ning, completely enclosing open €ood areas. it will also have�a smooth and cleanable floor (concrete, <br /> asphalt, dean tarps and smooth wood are acceptable)and censiTuctBd to separate Food and food preparation <br /> areas from the pubr�c. <br /> ❑ Other(specify): <br /> Note. The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods cram approved sources. <br /> 5, Approved water for drinking,utensil and hand washing Will be provided in my booth by the foilolrng methods: <br /> KApproved bottled waver <br /> 0 On-site hose bib that is connected to a potable ureter source. <br /> ❑Other(speciry): <br /> 7. Electricity is provided'fol.my booth's use_ Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during an timr as of booth oaera6on:jg�Yes❑No <br /> 9. 1 am providing the following hot temperature control for the loot holding of all potentially hazardous foods above <br /> 135T: <br /> ❑Camp stove ❑Stemo&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> Electric stove top AOtfter(specify) & t�' (n l <br /> Note: Examples of potertially hazardous food inclu L!- vla t t�coc t d b <br /> m ats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products_ <br /> IW8 E.daze#ton Avenue J Stocldon,CaUomia 95205 j T 209458-3420 I 1209464-0138 3 'VWv,sicehd_rn <br /> EHD ib� <br /> 7'ge 7 73 x <br /> �rrrra m <br /> TEMP E~r-rr Apv <br />