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S <br />Date(s): April 15,16 & 17.2016Name of Event: San Joaquin Asparagus Festival.1. <br />2. <br />3. <br />4. <br />5. <br />6. <br /> No7. <br />8. <br />9. <br />Pa^a V2 Ra* 10/14/2015 <br />Name of Organization/Business:_J <br />Address:_J <br />Yes <br />S H <br />San Joaquin County FOOD VENDOR HEALTH FORM <br />Vendors not in compliance can be asked to close their booth and forfeit the show. <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 organizer two (2) months prior to this event. <br /> No <br />The following is information about my organization/business: <br />Phone: / G> ' Alternate: <br />List food to be sold or given to the public: C <br />I am providing foods that are not homemade: Yes No <br />All foods are prepared on-site or are from approved commercial facilities: <br />Name of facility: —LlX <br />EH. Permit #: 4^09 ------------- <br />I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the <br />following methods: <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mesh fly screening, completely enclosing open food areas. <br />£3 A booth with a smooth and cieanable floor (concrete, asphalt, clean tarps and smooth wood are <br />acceptable). <br /> A booth constructed to separate food and food preparation areas from the public. <br /> Other (specify): _ _________________________________—----- <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water <br /> Hose-bib on-site at the festival. <br />Other (spec'rfy): 11 r <br />Electricity is provided for my booth’s use: IjQYes <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 p <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />’above 140° F: — <br /> Camp stove Double steamer Electric stove top <br /> Stemo & hotel trays Steam table & lids Other (Specify) <br />Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato <br />salad, eggs and dairy products. <br />vendors@SanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 fax