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Date(s): April 15,16 & 17, 2016Name of Event: San Joaquin Asparagus Festival1. The following is information about my organization/business:2. 3. 4. NoKI Yes 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Electricity is provided for my booth’s use: [X] Yes No7. 8. 9. No PHFs Page 1/2 Rev 10/14/2015 Name of Organization/Business:. Address:. Phone:_ I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. A 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. Ej other (specify): All products and samples are packaged 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 bottled water Hose-bib on-site at the festival. [3 Other (specify):N/A Brown's English Toffee_________________ 14385 Fiddletown Rd, Fiddletown, CA 95629______________ (209) 245-5400 Alternate:, (209) 296-4290 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. List food to be sold or given to the public: Prepackaged Candy I am providing foods that are not homemade: Yes No All foods are prepared on-site or are from approved commercial facilities: Name of facility: Brown's English Toffee E.H. Permit #: PFR# 58775 _________________________ San Joaquin County FOOD VENDOR HEALTH FORM Vendors not in compliance can be asked to close their booth and forfeit the show. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes No p|_|ps 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 Other (Specify) N/A Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs and dairy products. vendors@SanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 fax