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BA COUNTY <br /> N JOAQT�iN <br /> ENVIORMEN'TAL EEALTRDEPARTMENT <br /> �_' 1866 IB,�Haadsoor Avant,Stodctat,�`allfora'<ia 9�dS <br /> • s (M) 20 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food veadm(both for profit and non-pwff)are required to return a signed and complated copy of this <br /> chocklistrco the festival vaordimtar throe q weeim prior to this event. <br /> 1. Name of Event _ rG <br /> 2. The foUbwing is nafornaation about my ` <br /> Name of 'aahlbthsiness: k <br /> Address: dt f 6 <br /> 3. List food to be sold or givfttOftPublic. JMAMA <br /> 4. I am ptr Wft f+ood'tW is NOT prepared at hone: [►q Yes [ ]No <br /> AU food isprepando-dt ,or is ftm oonnmoraal fi iliidw. [Ayes ( ]No <br /> Name of£acuity►: Phone: e-�j 7,2 7—YI <br /> Address offsoilitg►: S" <br /> I am providing a booth with the Wowinx(to protect my unpackaged food cad food-preparat<oa areas from <br /> dust and the pkhc) <br /> m%A-boo&with-wWls sad vedbacomawxbed.af-cithw wood.canvas,plastic,spa materw and fine <br /> h fly gmcniM compiet*enclosing apah food areas It will also have a smooth and claw able floor <br /> (o mete,aphak claim tarps and smooth wood we acceptable)and conshwted to separate food and food <br /> preparation areas ftom the public. <br /> Now The only OPMAM wt required,to�prw&odowd.bootha am*osc whWh-sell bvvaagee from <br /> or poopedcapd.foods from approved sources. <br /> 6. Approved water for d diking.tonsil and hand washing will be provided in my booth by the following <br /> methods: <br /> DQ Approved bottled water. <br /> -p on-site-bow-bib that-is aonnected-so a poh6k water sue. <br /> [ ] Odxx( *): <br /> 7. Electricity is provided for my booth's arse: ]Yes [ ]No <br /> 8. 1 am providing an accuse probe Oxamometor to the but and cold Wding of potentially bmirdous <br /> foods dwiog all time of booth opaabote <br /> 9. 1 am providing the f&wing lint ftnpaWm 00001-fordWhot hddi9 of all potentially hI= d0W foods <br /> above 135 degrees Fak enheit: <br /> Camp stave [.,4,Do"ateamer [ ]Electric stove top <br /> [ ]Stem dt bote1 trays C ]Stesm table&lids [ ]odw(specify): <br /> Nota EUMAW of poWday hazardom food incl ea,oodked bnm rice veymbim <br />