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l S A N J O A Q U I N Environmental Health Department TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this Checklist to the festival coordinalor three(3)weeks prof to this event. ) , 1. 1.NameofEvent: t _ il` �'� ( ;c le" r 7PC,rw F�rate(s}: ;I •r : '.1 2. The following Is Information about my organizatiorilhuslness:J Name of organizabonlbusiness: + e k Jv. Address. Phone: ( ZOq ) y I Altemate;(2Dq ) 9 3. last food to be sold or given to the public- �c! - 4. 1 am providing food that is NOT prepared at home:[]Yes No All food is prepared on-siteor is from ap rold commercial facilities:❑k Yes❑No Name of facility: _ (�Ircy_e `1 1` Phone: 7 F `r It- 7 Address of facility.",Ej q P r[i ,.- 5. 1 am providing a booth wit),rthe following (to protect my unpackaged food and focal-preparation areas from flies, dust and the public) NN II�� ❑A booth with walls and ceiling constructed of either wood,canvas. plastic, similar material and fine mesh fly screening, completely enclosing open food areas. 11 wit! also have a smooth and cleanable floor (concrete, asphalt,clean tarps and smooth wood arc acceptable)and constructed to separate food and food preparation areas from the public. Other(specify): o k Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged roods from approved sources. a- Approved water for dnnkng,utensil and hand washing will be provided in my booth by the following imethods: ❑Approved bottled water. ❑On-site hose bib that is connected 44to a potable water source. Other(specify): ae hV,,,SVY ,S r s UC 7- Electricity is provided for my booth's use:®Yes F1 No S. 1 am providing an accurate probe thermometer to measure the hot and cold holding of poientlaily hazardous foods during all times of booth operation ❑Yes❑No QO\ 9, 1 am providing the following hot temperature control for the hot hoidng of all potentially hazardous foods above 135°F. U IN ❑Camp stove ❑Sterno&hotel trays ❑Double steamer ❑Steam table&lids ❑Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. https://drive.google.com/driveMoldarWl De6DU 1 sYdINVoiuxNU-ec—klmvJx5sgp