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SANJOAOUIN Environmental Health Department <br />H MPORARY POOD VENDOR’S APPLICATION <br />J Omer (Specif-/) <br />App'ovea water for drinking, utensil and hand washing will be provided <br />’ Approved bottled water <br />O' srie nose oib that is connected to a potable water source <br />h.K'.»rj> us <br />. On .J'.'’i420 <br />Noto Examples of potentially hazardous food include <br />voyotablos. potato salad, oygs, and dairy pioducts. <br />•: 'i ' .iiifomi.r !<!>. os i I <br />H1' <br />in my booth by the following methods <br />Alternate i u • / > <br />j Other (specify, <br />f tecfnc ty is provided for my booth's use I I Yes k-! No <br />; .'bvi'iing an accurate probe thermometer to measure the not and cold holding o* tontalfv <br />r-y/ls during all limes of tjooth operation T’l Yes [“] No <br />L.«o/.o:r'.g ’he following hot temperature control for the hot holding of all potentially hazardous foods atwe <br />f <br />Gamp stove [ J Sterno A hotel hays <br />IvOuoie Steamei |_J Steam table & lids <br />f lectnc stove top | J other (specify! <br />am providing food that is NOT prepared at home (Tfves Fl No <br />•* ’ood is prepared on-site or is from approved commercial facilities LT Yes No <br />Name of faedrty Phone <br />Address Of facility <br />am rovdmg a booth w.th the following (to protect my unpackaged~fo<rt and Sofpreparation Sms fromftes <br />dust and the public) <br />- oom with walls and ceiling constructed of either wood canvas plastic similar materia1 and fine mesh r".' <br /><reemng completely enclosing open food areas It w.ll also have a smooth ana cfeanable ‘kxx -con-re^ <br />aspnah cea- tarps and smooth wood are acceptable) and constructed to separate food and »ood nreparaG - <br />areas from the public <br />moats, tamales, cooked beans, nee <br />■profit) are inquired Io return a '.igund and - nn)p<m»’d c .■;>/ </ n '- i /■•■ <br />Noto The only operations not required to provide enclosed booths are those which sen beverages - ” <br />approved dispensers, or prepackaged foods from approved sources <br />■ •r * ' v ’.h-rs ,O| p|nf|{ <br />|3> s puiv to llus event <br />' V f £f w c <br />'*■■’5 is nloimation abtxil mv orsanizalionZbusmess <br />Name nt orpamzat.on/bi.smess T es <br />-5 CUAc <br />571,7 <br />uist food to be sold or given to the public lA.i. nA