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Environmental Health Department <br />/-ry-H Mi! <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />UM.e’hM <br />M <br />_ Alternate: (7^1 ) 7 <br />t~resca 5 <br />•? <br />■k SANJOAOUIN <br />------COUNTY------ <br />Greatness qrows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 coordinator three (3) weeks prior to this event. uumpieieo copy or mis checklist to <br />1. <br />/) <br />Ulis <br />S^HaZeltOnAVenUe| S,OCkto-C-f“0f |T 2i09 468-3420 I F 209464-0138 | www.sjgov.org/ehd <br />19 TEMP EVENT APP <br /> Date(s): ZL, r <br />I am providing food that is NOT prepared at home: S Yes No <br />All food is prepared on-site or is from approved commercial facilities: ® Yes No <br />Name of facility:---------------------------------------------------------------- phone. ( } <br />Address of facility: <br /> ' 3d^ and the puM^ With f°"0Win9: (t° Pr°teCt my unpacka9ed food and food-preparation areas from flies, <br />@ A booth with walls and ceiling constructed of either wood, canvas, plastic similar material and fine mesh flv <br />asphaT^eaZa'S0 haVe 3 S™°th and “ble'floor cXrete' <br />aXs from the pubke aCCeptable) and instructed to separate food and food preparation <br /> Other (specify): <br />Note: °peratior,s 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 />E Approved bottled water. <br />E On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: ® Yes No ----------------------------------- <br />1 SHa™ TXSXrthe hot and co,d holdin9 of potentially ha2ardous <br />* a^5PrF0Vldin9 the fo"owmg hot temperature control for the hot holding of all potentially hazardous foods above <br />E Camp stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />event. <br />1 Name of Event. /Ugry/f /zWUly <br />The following is information about my organization/business: <br />Name of organization/business: Snnl Alary if cP <br />Address: C rag fern <br />(AM). - OLbl <br />List food to be sold or given to the public: