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k Date(s): April 15,16 &17, 2016Name of Event: San Joaquin Asparagus Festival1. The following is information about my organization/business.2. 3. Alternate: 4. No 5. 6. NoYes7. 8. 9. Page 1/2 Rev 11/15/2014 Approved bottled water Hose-bib on-site at the festival. Other (specify):. San Joaquin County FOOD VENDOR HEALTH FORM Vendors not in compliance can be asked to close their booth and forfeit the show. 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. List food to be sold or given to the publiciJPi^s^^abhJ^lSjL-Pasiries.-. I am providing foods that are not homemade: Yes No All foods are prepared on-site or are from approved commercial facilities. f_iYes Name of facility: Willamette Vallgy Pie Co-..................................— E.H. Permit #:__2nQ21113__________________—--------------------------------------- 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 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. RJOther(specify): Commercial Mobile Food Concession Trailer Note: the only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Electricity is provided for my booth’s use: I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: >0 Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods ’above 140° F: NOT APPLICABLE 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. vendors@SanJoaquinAsparagusFestival.net • 209-466-5041 phone • 209-466-5141 tax Name of Organizatinn/Rusiness: GMB . LLC--------- Address: FOB 169 Aumsville. OF1. 97325 Phone:_5naz^l2zJL4M__ ___—------------—