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Dateisi: April IftAlLJffllSName of Event: San Joaquin Asparagus Festival1. <br />2. <br />3. <br />9^ 7^-2z ■////■i <br />3 <br />■1. <br />□■Yes <br />Approved water lor drinking, utensil and hand wusfiing will be provided th my booth by rhe following methods:6. <br />;r^ <br />Elwtreity is provided for my booth s use Q Ye$7 <br />3. <br />9. <br />7 <br />□.A booth with walls and ceding constructed of either wood, canvas, plastic. simSar material and line <br />mesh fly screening, completely enclosing open food areas. ‘ <br />□ A booth with a smooth and cieanablo floor iconcretc. asptiutt. ctcun tarps and smooth wood are <br />acceptablvl <br />□ A booth constructed to separate food and food preparation areas from the public. <br />[7JX5ther (specify): ------------------- <br />Note the only operations not required to provitifr enclosed booths are •.hose which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />AH lood vendors (both for profit and non-profit) are required to return a signed and completed copy ol 'Jus ClK;CkJ®t to <br />the festival organizer two (2'i months prior to this event. <br />"ikii <br />----^L <br />I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the <br />following methods: <br />San Joaquin County FOOD VENDOR HEALTH FORM <br />Vendors not in compliance can bo asked to close their booth and forfeit the show. <br />The following is ntonnatiori about my organization.'txisinct-s: <br />Name of Orr>an<7.itir>n/BufenoM:>2^^/^p/.r.^ ■ <br />Address t’r/>7y 7'7///'/ n7^7^ 1 c t- <br />Phone: Alternate: <br />/ T' <br />List food to bu sokl or given to the public <br />D-n<5" <br />0 Approved bottled water <br />0 Hose-bib on-s;te at the festival. <br />0 Other (specify): ‘Z? -77, <br />y ~~ T)7>if c7cn <br />.7 <br />I am providing foods that are not homemade: 0 Yes 0 No <br />AH foods are prepared on-srte or are from approved commercial facilities: QYes 0 No <br />Name of facility: , 7 7~77 i~j S . .’27”7% -A f , 7)^ <br />E.H. Permit «: 'hc .77 7/ c. <br />I am providing art accurate probe thermometer -o measure the ^and oiALnoidm.-i of potentially hazardous <br />foods during all taTuys of booth opnratiori 0 Yes 0 No <br />I am providing fre following hot temperature contrc^l fol- theftiot holding of all potentially hazardous foods <br />•above 140’ F: C / - -________ <br />0 Camp stove 0 Double steurr^r/ 0 Electric stove top <br />0 Sterno & t'otel frays 0 Steam table & lids 0 Other iSpecify) <br />Note: Potentialfy hazardous food examples: moats, tamales, cooked beans, rice, vegetables, potato <br />salad, eggs and dairy products.