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Environmental Health DepartmentSAN JOAQUIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />natft(s)Nov 28th, 2024 <br />1 <br />2 <br />Address <br />(209) 346-3113Phone <br />3 <br />4 <br />5 <br />those which sell Peverages from <br />6 <br />EJ On-site hose bit) that is connected to a potable water source <br />the hot and cold holding of potentially hazardous <br />9 <br />, i : <br />fSMP r '/EN f A/P <br />7 <br />8 <br />7> <D l(«)2 <br />r/ D’ <br />it)i> j' I' <br />I am providing food that is NOT prepared at home lX Tes O No <br />All food is orepared on-site or is from approved commercial facilities: IX yes No <br /> Name of facility: _______________________Phone. (--------J.------------------——- <br />Address of facility: <br />I am providing a booth with the following (to protect my unpackaged food and food-preparabon areas from tiles, <br />dust and tho public) <br />Alternate: ( )_ _______________ <br />List feed to be sold or given to the public: Ribs, brisket, pulled pork, sausoqe, mac, boons, cornbread <br /> Other (specify)'_______ <br />Electricity is provided for my booth's use l_] Yes XI No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation O Yes No <br />I am providing the following hot temperature control for (he hot holding of all potentially Hazardous ooi s a ov <br />135"R <br /> Camp stove Sterno & hotel trays <br />LI Douoie steamer lJ Steam table & lids <br />0 Electric stove top 50 Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Name of organization/business Hog House BBQ------- <br />133 N GRANT AVENUE, MANTECA <br />IyI A booth with wails ano ceiling constructed of ndhor wood, canvas, o-astic, similar material and line mesh fly <br />screening, completaly enclosing open food areas It will also have a smooth and cleanablo Hour L™ure <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Electric food warmer <br />meats, tamales, cooked beans, rice, <br /> Other (specify):_______________ <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from aporoved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />X Approved bottled water <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks prior to this event. <br />i Name of Event: Red White Brew wine and beerfest