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Date®: April 17,18& 16,2015Name of Event: San Joaquin Asparagus Festival1. <br />2. <br />3. <br />4. <br />5. <br />I are <br />6. <br /> No7. <br />8. <br />9. <br />I <br />209-466-5041 phone • 209-466-5141 faxPage 1/SR^ 11/15^014 <br />^2^1 fl-? PfeOcL. <br /> No <br />fit /x <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 />The following is information about my organizatlon/buslness: <br />d, T^tVe i <br />____Alternate:___ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water <br />O Hose-bib on-site at the festival. <br /> Other (specify): <br />Electricity is provided for my booth's use: [J/fYea <br />I am providing an accurate probe thermometer to measure the hot e nd cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holdin j of ail potentially hazardous foods <br />’above 140° F: <br /> Camp stove Double steamer Elect ic stove top <br /> Sterno & hotel trays ^fstearn table &. lids Other (Specify). <br />Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato <br />salad, eggs and dairy products. <br />vandors@SanJoaquinAsparagusFestival.net * <br />my organizatlo <br />Name of Organization/Business: I r^T <br />Add ress: <br />Phoned Ct 3^ _____ <br />List food to be sold or given to the public:. <br />I am providing foods that are not homemade: YesI am providing foods that are not homemade: QYes e/no <br />All foods are prepared on-site or are from approved commercial facilities; [Z Yes <br />Name of facility: <br />E.H. Permit#: P ?-(4 _________________________ <br />I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the <br />following methods: <br />PI 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 /> A booth with a smooth and cleanabl© floor (concrete, asphalt, clean tarps and smooth wood <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.