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SAN JOAQUIN <br /> <br />Environmental Health Department <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 <br />1 1 Name of Event ...)—AM/ <br /> <br />te-A49,e1A/CC-4q7 Date(s) 10 -ItC6 <br />2 The following is infomiation about my organization/business <br />Name of organization/business jiirzy <br />Address ('S A.2,1 tcr 1So k,kcy <br />Phone (.20. I c? Alternate ( ) 39 7/7? 2 <br />3 List food to be sold or given to the public <br />4 I am providing food that is NOT prepared at home El Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities eYes 0 No <br />Name of facility. 10:1) p0.319- teht-/(J /ki Phone ( 9- 'Si .7 7 ili <br />Address of facility <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 ceiling constructed of either wood, canvas, plastic. similar material and fine mesh fly 1 .' <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 />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 />6 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />eApproved bottled water <br />El On-site hose bib that is connected to a potable water source <br />[1] Other (specify) <br />7 Electricity is provided for my booth's use 12(Yes LI No <br />8 I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation. LI Yes LI No <br />9 I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T <br />ID Camp stove ..eSterno & hotel trays <br />Double steamer p Steam table & lids <br />Electric stove top Ej Other (specify) <br />LF <br />1868 E liazeltori Avenue I <br />PID if,02 <br />94,294023 <br />Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www sjgov orgiehd <br />Page 7 01 11 TEMP rvENl APP <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.