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Environmental Health DepartmentSAN JOAQUIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date; s j 1 1 Name cf Event <br />The fo owirg ;s informal on about my organizattorrbusiness <br />f- <br />'ji (i.Address J L <br />Phone • >7V^ j Alternate I )____ <br />I / 'i~i. /• f‘~ *3 1 st foco to be- sold oi given to the pub ic <br />z <br />5 <br />[□ Othe’ (specify) <br />Approved water ter drinking utensil and hand washing will be provided in my booth by tne following methodsp. <br />'Fn Approved bottled water <br />[_ Or-s te hose Dib tnat is connected to a potable water source <br />8 <br />9 <br />meats, tamales, cooked beans, rice. <br />7 F <br />Tf ”<• L . • M AS T <br />Note: The ony operations rot requ red to provide enclosed booths are those whch sell beverages from <br />aoproved dispensers or prepackaged foods from approved sources <br />O Stemo & hotel trays <br />[ ] Steam table & • ds <br /> Other (specify) <br />Name of organizat or business <br />zi f.’n ' <br />[_ A booth with walls and ceiling constructed of either wood canvas plastic sim lar materia, and fine mesh f y <br />screening complete y enclosing open food areas It will also have a smooth and deanabe floor (concrete <br />asphalt c ear- tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas frem the cub! c <br />Note Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />tf» <br />■ IL //• (’ I C 1 <br />A . food venders (both fo1 piol t and non profit) are requ red to return a s gned and comp eted ccpy of th s d eck <st to <br />the festival coordinator three (3) weeks prior Io Uns event <br />Li other I spec fy I ____________ ______________ __________ <br />Electncity is prev ded for my booth s use [ j Yes R No <br />I am prevding an accurate probe thermometer to measure the hot and cold ho ding o’ potentially hazardous <br />foods dur ng aJ times o’ pooth operat on 0 Yes No <br />I am D'ovia n.g the follow ng not temperatire control for the hot holding o’ all potentially hazardous foods above <br />135 F <br />’ Camp stove <br />L_ Doub e steamer <br /> Electric stove top <br />T- A <br />I am prov d ng food tnat is NOT prepared at home Pl Yes I ] No <br />All food is prepared on-s te or is from approved commercial facilities [*] Yes O No <br />Name of facility __ f < » J> v/./•1 ,* >Phone > ) S1; Ay i_____________ <br />Adoress of facility______7 • - \ / 7': it c 1 * > O !______' r- ’ i V "t •__________________ <br />I an providing a booth with the following (to protect my unpackaged food and food-preparation areas from f es <br />dust and the public!