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102205 Date(s): April 15,16 & 17,20161. 2. 3. 4. No 5. 6. 7. 8. 9. Page 1/2 Rev 10/147201S Double steamer Steam table & lids San Joaquin County FOOD VENDOR HEALTH FORM Vendors not in compliance can be asked to close their booth and forfeit the show. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival organizer two (2) months prior to this event. Name of Event: San Joaquin Asparagus Festival The following is information about my organization/business: Name of Organizatinn/Business: > LLX---------------------------------------------------------- Address: .... __________T— Phone: |‘-.v Alternate: — List food to be sold or given to the public: i-lc>~ SAUQ-r, HC.KL& t (, AMDY. I am providing foods that are not homemade: □xres No All foods are prepared on-site or are from approved commercial facilities: □Ves I Name of facility: kln iTHIFM--------------------------------------------- E.H. Permit #:—---------------- I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: EJA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. booth with a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable). A booth constructed to separate food and food preparation areas from the public. Other (specify):_ ___ ___________:------- --------------- Note: the only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. □^Approved bottled water Hose-bib on-site at the festival. Q-'bther (specify): ‘.-TTAftoM --------------------------------------- ------------------------ Electricity is provided for my booth's use: □'S'es No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Q^Ves No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods *above 140° F: Camp stove Double steamer Electric stove top Sterno & hotel trays Steam table & lids 0'Other (Specify) -------------------------- Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs and dairy products. venciorsYSanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 fax