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JlfiJ <br />Environmental Health Department <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />5 * <br />7. <br />8. <br />Date(s): / 7 <br />-SS I cl/ <br />tySZoz. <br />SAN JOAUUIN <br />-----COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) ’ <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />t0 return a si9ned and comP|eted copy of this checklist to <br />1 Name of Event: i Q 4" /llfl r y /J <br />The following is information about^organization/business: <br />Name of organization/business: /Ugry/ f (yf 7/]^ <br />Address: -30 3 fc LlYl£h C j S'k'cfctw fl & <br />~ Qb U I Alternate: ( 2^9 ) " /2_Q'4H <br />List food to be sold or given to the public: Cf p a S' / Q _________________ <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: 0 Yes No <br />Name of facility:--------------------------------------------------------------------- { <br />Address of facility:_______________ <br />' ^and the pX? Wi‘h f0"°Win9: (t° PrOteCt my unpacka9ed food and food-preparation areas from flies, <br />0 A booth with walls and ceiling constructed of either wood, canvas, plastic similar material and fine mesh flv <br />asoTaTciean^ nseanrtnCl0Slnth f00d areaS' “ Wi" a'S° haVe a smoofh and ctea™ble floor (concrete <br />areastfromThe public ar6 acceptable) and constructed to separate food and food preparation <br /> Other (specify): <br />N°te: looroved Xa*'0"8 nOt t0 Pr°Vide enC'°Sed b00thS are those which sel1 beverages from <br />approved dispensers, or prepackaged foods from approved sources. y <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />13-On-site hose bib that is connected to a potable water source. <br /> Other (specify):______________ <br />Electricity is provided for my booth's use: JS Yes No ----------------------------------------------------- <br />' fXdXTS the hot and cold h0,dinp of p°‘-«a"y b-dous <br />' Pjovid.ng the following hot temperature control for the hot holding of all potentially hazardous foods above <br />CamP stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top 0. other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />S“HaZeltOnAVenUe| StOCktOn'Ca,ifomia9520pbgl T 209468-34201 F 209464-0138 | www.sjgov.org/ehd <br />u&/19/19 9 TEMP EVENT APR