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SAN JOAQUIN COUNTY ' ENVIORMENTAL HEALTH DEPARTMENT 1%8 Fast Hazeften Avenue,Stmicton,Cafforetht 9S205 ti,.-�' drdaena: (209)468-342,0 TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)art required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. l. Name of Event: Da g)• 2. The following is information about my organizabon/business: {(�` Name of on/busmess: .Cur -�✓ /� `" � `-' S' ` - - -- — Address: P6f tX l615 Phone: �� 7�-? , Alternate: 3. List food to be sold or given to the public: 4. I am providing food that is NOT prepared at home: [.Q Yes [ ]No All food is prepared on-site or is from approvpd commercial facili,ties: ( Yes ( ]No Name of facility: Phone: Address of fsoility: -5— I am providing a booth with the following: (to protect my unpacks pd food and food-preparation area from flies,dust and the public) [A A booth with walls and ceiling constructed of either wood, canvas,plastic, similar material and fine meth fly screening,completely enclosing open food arras. 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. [ ] Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. [ On-site hose bib that is connected to a potable water source. [ ] Other(specify): 7. Electricity is provided for my bootie's use: ] Yes [ ]No 8. I am providing an accurate probe thermometer to easure the hot and cold holding of potentially hazardous foods during all time of booth operation_ [ es [ j No 9. I am providing the following hot temperature control for the lint holding of all potentially hazardous foods above 135 degrees Fahrenheit: Camp Stove (Double steamer [ J Electric stove top [ ] Stern&hotel trays [ ] Stcam table& lids ( ] Other(specify): - Note:Examples of potentially hazardous food include: meats,tamales,cooked beans,rice vegetables, potato salad,eggs and Barry products.