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Environmental Health Department »^es* Date(s): / / - Z- - 21.Y 2. TYta A i's cA Phone: 3. 4. 5. f 6 Other (specify):a 6. 9. meats, tamales, cooked beans, rice, r—---- 7. 8. SAN JOAQUIN ------COUNTY------ Greotness grows here. TEMPORARY FOOD VENDOR’S APPLICATION V r gj [ c r Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ' ^Approved bottled water. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. On-site hose bib that is connected to a potable water source. Other (specify): Electricity is provided for my booth's use: 0Yes No ~ ~ I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 0 Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135 F. Camp stove Q Stemo & hotel trays Double steamer steam table & lids Electric stove top other (specify) g c* $ Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 1 .Name of Event: D cs Y fl f Tk, < T) E7 A.^ The following is information about my organization/business: Name of organization/business: k-5 Address: /5 C Iaa'? V/? I' f n (2°Y ) ° V- Alternate^ ) List food to be sold or given to the public: Fun. Act CoVcs deep PrfcJ grU CzA. cccmg VcAVleS feedbrs I am providing food that is NOT prepared at home: Zfves No All food is prepared on-site or is from approved commercial facilities: EfYes No Name of facility: "5 g V Phone: (32? ) 7 7 Address of facility: V / T'Q A CA I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public)