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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 2^7^) <br />3. List food to be sold or gjm to the public; <br />} <br />t, <br />[ j StemQ&hotel trays [] Steam table & lids <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTBDEPARTMENT <br />1868 East Hanitoo Avene, Stoektoa, CaMforaia 95205 <br />BaafaKW (200)468-3420 <br />Affiiate: ^7 <br />[]N6 <br />the hot and cold holding of potentially hazardous <br />to [ J No <br />forthe hot holdmg of all potentially hazardous foods <br />All food vendora (both for profit and non-profit) are required to return a signed and completed copy of tins <br />(^klisno the festival coordinator three Swedes prior to this event <br />The only operations not required to provide eaclosed bootfo are those wirich sell beverages from <br />approved dispensers, or prepackaged foods frmn approved sources. <br />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br />methods: <br />bC Approved bottled water. <br />On-site hose bib that is connected to apotable water source. <br />[ ] Otter (specify): <br />7. Electricity is provided for my booth’s use: Yes <br />8. I am providing an accurate probe thermometer to measu <br />foods during all time of booth operation: <br />9. I am providing the following hot temperature <br />above 135 degrees Fahrenheit: <br />Camp Stowe [^Double steamer [] Electric stove top <br />[] Sterna & hotel trays [] Steam table & lids [] Other (specify): <br />Note: Examples of potentially hazardous food include: meals, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />4. lamprovidmgfoodthMisNOTpreparMathome: KJYes [ JNd <br />All food is prepared oortite or is from approved commercial fircilities: MYes [ ]No <br />Name of focility. Phone: <br />Address of facility: S/- ZpcjggAcg <3^- <br />5. lam providing a booth with the following: (to protect my unpackaged food and fbod-preperatum areas from <br />files, dost and the public) z <br />M A booth with walls and ceffingconstnicted ofnither wood, canvas, plastic, similar material and fine <br />mwhfly screening, completely enclosing open food areas. It will also have a smooth and clcanabte floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparatkm areas from the public. <br />[ j Other (specify)::______________________________________ <br />Note <br />1. Name of Event 7^3-f ' <br />2. The following is information about my organization/business: <br />Name of or^mizstkm/businKB: <br />Address: <br />Phone: 7^?-5^