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■4 <br />Environmental Health Department <br />i.Date(s): <br />2. <br />Address:9 ^3 h <br />Phone:) <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />N /A <br />Si <br />i <br />i <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />@ Approved bottled water. <br />7. <br />8. <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />-----C OU NTY------ <br />Grcorness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />are required to return a signed and completed copy of this checklist to <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: ® Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ® Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes 0 No <br />Name of facility: /A Phone: ( )_______________ <br />Address of facility;N <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify): <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />J.Name of Event: 0130^^3 ill \ r C CQ c) DCj <br />The following is information about my organization/business: <br />Name of organization/business: <br />(ao <br />List food to be sold or given to the public: f <br />meats, tamales, cooked beans, rice, -1;.. <br />Slocktpn.California952051 ^209468-34201 F 209464.0,38 | <br />Popcorn <br />Alternate: ( <br />Com______