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Date(s): April 15,16&17, 2016Name of Event: San Joaquin Asparagus Festival1. 2. 3.ganization/Business:/ 4. No'esire< 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. No.7. 8. No 9. (Me 77) vendors@SanJoaquinAsparagusFestival.net • 916 -370-3647 phone • 209-234-1780 faxPage 1/2 Rev 10/14/2015 Approved bottled water □idose-bib on-site at the festival. Other (specify): Electricity, is.provided-for. my-booth’s.use: . □Yes I am providing an accurate probe thermometerto'measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 'es No . on-site or are from approved commercial facilities: 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 Jy screening, completely enclosing open food areas. .A'booth with a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are '' acceptable). booth 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. Name of Org^pizatjon/Bysines: Add ress: , ______ Phone^Pb^J Alternate: ) List food to be sold or given to the public: I am providing foods that are not homemade: All foods are prep, 'Name of facility: - E.H. Permit #: 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. San Joaquin County FOOD VENDOR HEALTH FORM Vendors not in compliance can be asked to close their booth and forfeit the show. neter t< □.Yes I am providing the following hot temperature control for the hot holding of all potentially hazardous foods *above 140° F: F"] Camp stove Double steamer Electric stove top Sterno & hotel trays Steam table & lids Other (Specify) Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs and dairy products. The following is information about my organization/business: /WL. K Alternate: 5 )