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JOAQUIN <br /> <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Al: food vendors (both for profit arid nonprofit) are required to return a signed and completed copy of this checklist to <br />Me festival coordinator three (3) weeks prior to This event <br />1 1 Name of Event • _TO TiODEppaDzfu c_E; AY Date(s) <br />The following is information about my organizaborybusiness <br />Name of orgarnzationThusiness IFI. NLL. rA CroRy <br />Address 4000 T -rEJS2Q PL.tfiL /I tQICHQ CIhj q1132Y <br />Phone (12 G 6_4 - CS:25_1. Alternate• ( ) <br />3 List food to be sold or given to the public vec-) vCci B -reyityjs_r_paLEV..uP-PY <br />4 I am providing foOd that is NOT prepared at home: glYes EI No <br />All food is prepared on-site or is from approved commercial facilities k/ces EJ No <br />Name of facility C.CE Phone (1)-5-) 6 - 5oS- I <br />Address of facliltf Q_D_Q eJ611...1 , cu.-LILA 00 , PIE ii.SLW rar,),_CA_14-5 tg <br />5 I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />A booth with walls and ceilng constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt. clean tarps and smooth wood are acceptable) and constructed to separate food and food preparaton <br />areas from the public. <br />111) Otner (specify) <br />Note The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />6 Approved water for drinking, uiensil and hand washing will be provided in my booth by the following methods <br />[1] Approved bottled water. <br />ID On-site hose bib that is connected to a potable water source <br />[j Other (specify) <br />7 Electricity is provided for my booth's use Yes Li No <br />8 I am prong an accurate probe teerni,xiieter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation I Yes I No <br />9 I am provictng the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135*F <br />TI Camp stove F/Sterno & hotel trays <br />E.] Double steamer [J Steam table & lids <br />[" Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include, moats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Hannon Avenue I Stockton Caillornia 1:6205 T 209 468-3420 I F 209 464-0138 vvv.isv sjgov <br />'POO* CI 11 7 I MP 't