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Date(s): April 15, 16 & 17, 2016Name of Event: San Joaquin Asparagus Festival1. 2. 3. Alternate: List food to be sold or given to the public: Carbonated Soda4. Yes No 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. No7. 8. 9. vend0rs@SanJ0aquinAsp3ragusFestival.net • 209-466-5041 phone • 209-466-5141 faxPage 1/2 Rev 11/15/2014 I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: Approved bottled water iQ 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. 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. 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. □'Other(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. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: O Yes No The following is information about my organization/business: Electricity is provided for my booth’s use: Yes I am providing foods that are not homemade: Yes No All foods are prepared on-site or are from approved commercial facilities: Name of facility: E.H. Permit #:__________________ Name of Organization/Business: GMB , LLC Address: FOB 169 Aumsville, OR 97325 Phone: 503-949-4434 _