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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. No 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: [>Jd''es No7. 8. 9. Page 1-2 Rev 10/14/2015 I 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 SApproved bottled water Bflose-bib on-site at the festival. Other (specify): I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: / Cc: kf S 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. Name of Organization/Business:P9/3"'o ; Address: /V/p ?’ t R Phone: f/ 7 - Q V ,7 - 7.3 Alternate:. 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 the following hot temperature control for the hot holding of all potentially hazardous foods 'above 140° F: Camp stove Double steamer Electric stove top /(/o 1 n<9" Sterno & hotel trays Steam table & lids □'Other (Specify) Ay/I- ordv-- 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 //'t-'uoc Sv/-.507- 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. □Other (specify): cnc .c.lkz Au.ff- dortCf-sS, dn Note: the only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. J nt-,r.s 6>re.a.^>zF c/Ot-mj Ccfccs hc-e p Tr I am providing foods that are not homemade: S-^es No All foods are prepared on-site or are from approved commercial facilities: H^es Name of facility: /fy/y4- Ppe.pz:^r J <^6. on 516-0 E.H. Permit #:_