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"¥3'7 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I <br />9. <br /> <br />[ ] Sterna & hotel trays [ ] Steam table & lids <br />-jLor. <br />• iii <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTBDEPARTMENT <br />1868 Aww®, <br />Bosfaimx 009)468^420 <br />, h — u mi „ | | |- - , i —|-rn»»«ii»iii»liiirj 7n»i»i ' ~ir-| r. <br />AH food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />DateCsV <br />Alternate: <br />9 <br />1 <br />i <br />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br />■ methods: <br />M Approved bottled v/gter. <br />M On-site hose bib that is connected-to a potable water source. <br />[ ] Other (specify): <br />7. Electricity is provided for my booth’s use: J <br />8. lam providing an accurate probe thermometer to <br />foods during all time of booth operatiem: [ <br />4. I am providing food that is NOT prepared at home: KJYes <br />All food is prepared on-site or is from approved commercial facilities: | <br />Name of focility: <br />Address of facility: <br />I ]No <br />i ( ]No <br />checkiistSo foe festival coonfoiator fore© (3) weeks prior to this event <br />1. Nam© of Event: <br />2. ThefoHcwringisinfoimatiimabommy organi^onfousi^ / <br />Name of or^nixatian/business: <br />Address: __ ____ <br />Phone: V’^-? .. • <br />3. List food to be sold or given to foe public: <br />MYes <br />Phone: ___ <br />___________ __ ______ _________ a> ~ <br />5. I am providing a booth with foe following: (to protect my unpackaged food and foofopreparation areas from <br />flies, dust and foe public) <br />y A booth with walls and cefopg constracted of either wood, canvas, plastic, similar material and fine <br />m«fo fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from foe pfolic. <br />[ j Ofofir (specify):______________■ ______________________________________ <br />Note: The only operations notrequked to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />JYes [JNo <br />measure foe hot and cold holding of potentially hazardous <br />[^Yes f INb <br />I am providing the following hot temperature control for foe hot holding of all potentially hazardous foods <br />above 135 ctegrees Fahrenheit: <br />r«mp Stave [^Double steamer [ ] Electric stove top <br />[ ] Sterna & hotel trays [ ] Steam table & lids [ ] Other (specify): <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products.