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Date(s): April 15,16 & 17, 20161. <br />2. <br />3. <br />t <br />■H4. <br /> No'es <br />5. <br />6. <br />Electricity is provided for my booth’s use:7. <br />8. <br />9. <br />Page 1/2 Rev 10/14/2015 <br /> Electric stove top <br /> Other (Specify) <br />List food to be sold or given to the public:_: <br />I am providing foods that are not homemade: <br /> Approved bottled water <br />ElHose-bib on-site at the festival. <br /> Other (specify): <br />Cnb-ini * 91^-370-3647 phone * 209-234-1780 tex <br />|^]Yes No <br />er to measure the hot and cold holding of potentially hazardous <br />Yes O No <br />illy hazardous foods <br />I am providing an accurate probe thermom; <br />foods during all times of booth operation: <br />providing the following hot temperature control for the hot holding of all potentially hi <br />The following is information about my organization/business.. <br />Name of Qrganiz^ten/Busineg: Address: W • W W , s ------------- <br />Phnne:,^ -----Alternate:,-------------- <br />\C& <br />‘ : 3Q Yes DNo <br />All foods are prepared on-site or are from approved commercial facilities: O5 <br />Name of facility: —----------------------------- ---------------------------- -— <br />E.H. Permit #:_ _ _—---------------------------------- <br />I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the <br />following methods: <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mesh fly screening, completely enclosing open food areas. <br /> A booth with a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are <br />acceptable). <br /> A booth constructed to separate food and food preparation areas from the public. <br />D N^e: theOTfyoperations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />I am <br />‘above 140° F: <br /> Camp stove Double steamer <br /> Sterno & hotel trays Steam table & lids <br />Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato <br />salad, eggs and dairy products. <br />*4 rt M 1 <br />San Joaquin County FOOD VENDOR HEALTH FORM <br />Vendors not in compliance can be asked to close their booth and forfeit the show. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival organizer two (2) months prior to this event. <br />Name of Event: San Joaquin Asparagus Festivaj