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\ki <br />Date(s): April 15,16 & 17, 2016Name of Event: San Joaquin Asparagus Festival1. <br />2. <br />3. <br />4. <br /> No <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> NoElectricity is provided for my booth’s use: K Yes <br />8. <br />9. <br />MRiiclor8eSBnJoaquinAspafagusFe5tiVBl.net • 916-370-3647 phone • 209-Z34-1780 f«xPage 1/2 Rev 10/14/2015 <br />I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the <br />following methods: <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 />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 <br />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 />K booth with a smooth and cleanable 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 />San Joaquin County FOOD VENDOR HEALTH FORM <br />Vendors not in compliance can be asked to close their booth and forfeit the show. <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 />O Sterno & 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 /> Approved bottled water <br /> Hose-bib on-site at the festival. <br />3 Other (specify): A -trxrA'V' <br />List food to be sold or given to the public: C. cSo <br />I am providing foods that are not homemade: [53 Yes No <br />All foods are prepared on-site or are from approved commercial facilities: &Yes <br />Name of facility:_ ___________________ <br />E.H. Permit #:.__ ___________________________________________ <br />The following is information about my organization/business: <br />Name of Organization/Business: 4<,<g44Ae. Vkarvx <br />Address: * O rSzi ? 11€. j X. A ( <br />Phone:. 5>Bo- _____Alternate: