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<br />AiNinnew„-L- <br /> <br /> <br />REC-008 <br /> <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br /> <br />COUNTY-- <br /> <br />, <br />\Lit <br /> <br />Greatne!, rows ; <br /> <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. G -1- <br />Kite Festivp • /),(71- <br />1.Narne of Event: utz.. .c-etili ti 1 hi -TAIL 1 HUA14 litirr Dat(S): <br />. .2..0 2y <br />The following is information about my organization/business: g- -; -7- 27 <br />(7 <br />Name of organization/business: /7776 / -Z_., 2 //hAv_.....2.? <br />/141-karz. Q5—?3 <br />Alternate: ,S7Q /-3- /2 79 <br />List food to be sold or given to the public: ./----4e-1-7-c-41 nizzir <br />I am providing food that is NOT prepared at home:PesDo <br />All food is prepared on-site or is from approved commercial facilities:EYes <br />Name of facility: Ay, <br />Address of facility: <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 />Address: J.; 5S' <br />Phone: 3 <br />Phone: <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />ing, 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 />[lather (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 />UApproved bottled water. <br />FIDn-site hose bib that is connected to a potable water source. <br />Pther (specify): <br />ectricity is provided for my booth's use. <br />I am providing an accurate probe the <br />foods during all times of booth operation <br />I am providing the following hot ternperatu <br />amp stove <br />ouble steamer <br />lectric stove top <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 I www.sjgov.org iehd <br />MD 16-02 Page 7 of 11 TEMP EVENT AAP <br />Of:1T19 <br />No <br />asure the hot and cold holding of potentially hazardous <br />the hot holding of all potentially hazardous foods above <br />4t <br />emo & hotel trays <br />team table & lids <br />her (specify)