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Name of Event: San Joaquin Asparagus Festival Date(s): April 15, 16&17, 20161. 2. 3. 4.List food to be sold or given to the public:. I am providing foods that are not homemade: No 5. 6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Yes7.Electricity is provided for my booth’s use: 8. 9. O Double steamer Electric stove top vendors@SanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 faxPage 1/2 Rev 10/14/2015 Approved bottled water 1^1 Hose-bib on-site at the festival. Other (specify): I am providing the follow ng hot temperature control for the hot holding of all potentially hazardous foods *above 140° F: Camp stove 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. H No 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. 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 The following is information about my grganization/business: Name of Orqanization/Business: Address: pfo • Phone: Alternate: ,: □'Yes No All foods are prepared on-site or are from approved commercial facilities: ETYes Name of facility:, / ____________________________________ E.H. Permit #: I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: H 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. O 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.