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Date(s); April 15,16&17, 2016Name of Event: San Joaquin Asparagus Festival1. <br />The following is information about my organization/business:2. <br />3. <br />(559) 250-6546 <br />List food to be sold or given to the public:.4. <br /> No Yes <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> NoElectricity is provided for my booth’s use: Yes7. <br />8. <br />9. <br />Page 1/2 Rev 10/14/2015 <br />I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the <br />following methods: <br /> Approved bottled water <br /> Hose-bib on-site at the festival. <br /> Other (specify): <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 /> Other (specify):-------------------------- ------------------------------------------------------------------------- -------- <br />Note: the only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <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 Organization/Business: BJO, LLC dba Olde Tyme Kettle Korn <br />Address: P.O. Box 2038, Clovis, CA 93613 <br />Phone: (559) 323-7677 Alternate:. <br />Kettle Korn, Frozen Lemonade, Mangonada <br />Bubble/Boba Tea <br />I am providing foods that are not homemade: 0 Yes No <br />All foods are prepared on-site or are from approved commercial facilities: <br />Name of facility: <br />E.H. Permit #:_____________ <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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />‘above 140° F: <br /> Camp stove Double steamer Electric stove top <br /> Sterno & hotel trays Steam table & lids Other (Specify)----------------------------------- <br />Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato <br />salad, eggs and dairy products. <br />vendors@SanJoaquinAsparaiiusFestival.net • 916-370-3647 phone • 209-234-1780 fax <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No