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IMG_20240213_031547_956.webp (1OL 920) <br />) <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />1 Name of Event. 1 <br />2. <br />Address <br />Phone.() <br />List food to De sold or given to the public 3. <br />4 <br />5 <br />Food trailer <br />Approved water lor drinking, utensil and hand washing will be provided in my booth by the following methods:6 <br />approved bottled water <br /> On-site hose bib that is connected to a potable water source <br />9. <br />F 2G9 4G4 013H <br />1/1file:///C:/Users/hburkhart/ADDData/Local/Microsoft/Windows/INetCache/Content.Outlool</l69P5H16/IMG 20240213 031547 956.webD <br />7. <br />8. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />135*F: <br /> Camp stove <br />Q Double steamer <br />Q Electee stove lop <br />.vw.v 3;gcrv O'g.-el d <br />TEMP EVENT APP <br />,PM <br />SAN JOAOUIN <br />■Z CVJN ’ Y <br />_________ Alternate: ( ) <br />Fruit bowls and fruit products <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks onor to this event <br />RWBfest <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal and fine mesh fly <br />screening, completely enclosing open food areas It will also nave a smooth and cleanabie floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed io separate lood and food preparation <br />areas from the public <br />f^Other (specify): <br />The followtng is informatton about my oroamzation/business: <br />Nam..! Fruitopia Fruit Bowls <br /> 821 kilarney court lathrap ca 95330 <br />2099697292 <br />F’ Other (specify) ______________________________________ ____________ <br />Electricity is provided lor my booth, s use ® Yes L_ No <br />l 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 ol all potentially hazardous foods above <br /> Sterno & hotel trays <br />O Steam table & lids <br />FpOther (specify) N/A HO Hot foods <br />meats, tamales, cooked beans, rice, <br />I am providing food that is NOT prepared at home, Yes No <br />All lood is prepared on-site or is from approved commercial facilities. F#Yes No <br />Name of facility:Phone: (] <br />Address of facility <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 />IBfirtE Hazelton A/Uliue SlOf.klon C ihlorr ia 95205 , T 209 4tjfF3420 <br />Eho 1641? P-igcrcI” <br />oetflO <br />Patels): March 23 2024