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Lome - -COUNTY— <br />SANdOAQUIN <br />Environmental Health Department <br />',,,eS3A)", <br />urcotness 9 rob s here <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />AU 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 <br />1 Name of Event: INDIA INDEPENDENCE DAY Date(s) 03 /I°/' C) <br />2 The following is information about my organization/business. <br />Name of organization/business c HAAT 8HAVAN flouNTAIN viEw <br />Address: <br />I am providing food that is NOT prepared at home: Ei 'Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: "es 0 No <br />Name of facility: c WIRT- 61.01VAN mown Ain vtEui Phone: f4-08 77-1 1100 <br />F EL CAristio REAt ) Inoutir Rol VIELJ)CA - (v4_0 40 Address of facility: 165 <br />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 />0 A booth with walls and ceiling 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 preparation <br />areas from the public. <br />0 Other (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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />eiApproved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />7 Electricity is provided for my booth's use: 0 Yes Vrto <br />I am providing an accurate probe thermomi to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 01 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />o Camp stove orZemo & hotel trays <br />0 Double steamer LISteamlable & lids <br />0 Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 SNOV.org/ehdwww. <br />CHO 16 .02 Pao. 7 o4 I I <br />GO,25/2023 <br />TE tAP EvENT i• <br />IC5 E EL cfirlivo REAL ) Mourn-Airy view.) - 514-c, <br />Phone: (I.os) 1-13- moo Alternate: ( ) <br />3. List food to be sold or given to the public: 0( CSAf1e3.9 f)vii.,; tfrif_sa% riuud- Cita". L <br />Ek •