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1.Name of Event: San Joaquin Asparagus Festival Date(s): April 15,16 & 17, 2016 2.The following is information about my organization/business: 3. I ; V4. No 5. 6. 7. No 8. 9. vendors@SanJoaquinAsnaragusFestivaLnet • 91B-370-3647 phone • 209-234-1780 faxPage 1/2 Rev 10/14/2015 I am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following methods: □I Electric stove top Other (Specify) San Joaquin County FOOD VENDOR HEALTH FORM Vendors not in compliance can be asked to close their booth and forfeit the show. Electricity is provided for my booth’s use: Yes <4?__ •XJ a C-VcAf'c* 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): 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: Approved bottled water [3 Hose-bib on-site at the festival. Other (specify): Yes 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. •\x,. cb c m . Alternate: Name of Orqanization/Business: Ad d ress: Q H 3 \ \ Va i sT, ee Phone: Co(eA- List food to be sold or given to the public: I am providing foods that are not homemade: [t] Yes No All foods are prepared on-site or are from approved commercial facilities: Name of facility: E.H. Permit #: I am providing the following hot temperature control for the hot holding of all potentially hazardous foods ‘above 140° F: Camp stove Double steamer ''■•Q Sterno & hotel trays '"''Q Steam table & lids Note: Potentially hazardous food examples: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs and dairy products. 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