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SAN JOAQUIN Environmental Health Department <br />7 of 11 TEMPORARY FOOD VENDOR S APPLICATION <br />1 H«m® o* Event <br />2. <br />Adarcs» <br />( JOH )Phone <br />3 1st food to be sold a* gtwn to the pubt« <br />5 <br />s <br />0 Approved hotted watw. <br />O OMite hose b<b that« connected to a potable wafer aora <br />9 <br />meats, lasmale*. cooked beans, rice, <br />rtW’ MW M'Vt -lKK ; r J t s <br />r <br />9 <br />O Other (specify): —-------——,— ----------- -- --- <br />Note The only operat®mi not required to prawte gnctowto tooths are those which sal) toverages from <br />approved Aspensera. or prepackaged foods from approved sources <br />Approved water for drinking utensil and hand washing will to provided m my booth by the fotovwng methods <br />M feed vendors (both ter profit amd non-profili are required ta return a signed and completed wpy of tha tnecWst to <br />_E&lk <br />u %-j VS. <br />Ow festival mcmfinator trw (3) weeks pw id thm event. q rch^vc/ UctlblVf <br />1 <br />Nate; Examplo af patanthlly hazardous load inclose; <br />vegetables, potato aaUd, and dairy producU< <br />mi ' rwr-M? <br />LV J & <br />I .^. t, <¥> *> ...M <br />I am prowimg food that» MOI prepared nt home; Ef ¥•# O No <br />All teed is prepared on site w is lirom approved cwnmercial fsetlitiea: 0 Yes (J No <br />Name of taalrty ........................................................................Ptiooe L_*-——------------------------ - <br />Address of facility ....— _______________——————-— <br />I am providing a tooth with the toMowmg (to protect my unp»cxaged food and food-p-apmSon areas from fifes. <br />dust and ths public) <br />0 A booth with waBs and ceftng construcied of eittrer wood, canvas, ptosfec. simitar matanal and fine mesh fiy <br />screening, compfetety enclosing open food areas It wiH also have a smooth and clMMbte toor (concrete, <br />asphatt. clean tarps and smooth wood we acceptable) and constructed Io separata food and food preparation <br />areas from tee puM« <br /> Ottw (specify) ------------- -----—......... ..................... ....—......... <br />Electriesty a provided for my booth's usn Yes [J No <br />I am providing an accurals proto Ihwmomjta Io meaws tee hot and coM hoMng of potanbally twuardous <br />food? during all time-a ct tooth operation ©'Ye® O No <br />I am provufeng the foltawing tot temperature coolrol (or Ihe tot holding of a« potatteaily ha^artos foods above <br />135'F _ <br />fl Camp stove O Stemo 4 hotel frays <br />A DouWa steamer O Steam taWs 4 Ms <br />D Efectnc stave top 0 Othw (speisly) <br />tA RSK5 ___ <br />Cooc<• J CSv _________ <br />Tto falowteg is Morrnoton about my wganfeatotetoairms <br />Name of orgisnizatombusirwss Ou ACreeS. <br />~7iA Lw <br />55k 35^ _ AltiBfnare <br />t\ * a % akA S