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Date(s): April 15, 16 & 17, 2016Name of Event: San Joaquin Asparagus Festival1. 2. 3. 4. ^s 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Yes NoElectricity is provided for my booth’s use:7. 8. 9. Double steamer s Page 1/2 Rev 10/14/2015 LC No I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: O Approved bottled water -Ej Hose-bib on-site at the festival. Other (specify): I am providing the following hot temperati "above 140“ F: S' Camp stove 'EJ Double steamer Electric stove top Sterno & hotel trays Steam table & lids 0Other (Specify)]^ 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 ire control for the hot holding of all potentially hazardous foods List food to be sold or given to the public: 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. 0A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine meshjly screening, completely enclosing open food areas. Q^booth with a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable). xQ^Tbooth 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. I am providing an accurate probe thermometerro measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Qres O No San Joaquin County FOOD VENDOR HEALTH FORM Vendors not in compliance can be asked to close their booth and forfeit the show. The following is information about my organization/business: Name of Organization/Business:\jAj^<>^~ (/ /a ,-----------------—---------- AddressT^^/Z* -Sf-t' /oj Phone:9^ 52/ ______Alternate: .C'ofT' Q'J I am providing foods that are not homemade: P'Yes EJ No All foods are prepared on-site or are from approved commercial facilities: Name of facility:~ E.H. Permit #:.________________