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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 /> <br /> <br />Kite FestivE Juneteenth 4 of July MIP Jul, Aug <br />1.Name of Event: Date(s): <br />6/1 6/15 7/4 7/20 <br />Cultural Celebration _Lightels11::: Main Street <br />The following is information about my organization/bUSin <br />8/17 9/21 12/6 <br />tern° & hotel trays <br />Steam table & lids <br />Other (specify) <br />REC-008 <br />SAN JOAQUIN <br /> <br />Envorirnttita Hea1h DepEutmerot <br />COUNTY— <br />Greatness grows here, <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Name of organization/business: ,.,....-Yvaas.. i V1\135 i L Q C., 6 VI" Lk C' <br />Address: E eG 54t,ocK.ttor '21 52,1 5 <br /> <br />Phone: 5lo 65o 841 1-1- Alternate: <br />List food to be sold or given to the public: (3 RIALi (AN Fool) <br />I am providing food that is NOT prepared at home: es \lo <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: A Iwo19-x);:be C./ O-W-1— <br />Address of facility: .-7 q /44" (- \-A l-kw lot•I <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 />.) <br /> <br /> boothwith walls and ceiling constructed of either wood, canvas, plastic, similar material and tine mesh fly <br />ening, 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 />Dther (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 />FlApproved bottled water. <br />[Ian-site hose bib that is connected to a potable water source. <br />Pther (specify): <br />ectricity is provided for my booth's use Yer No <br />I am providing an accurate probe the asure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation o <br />I am providing the following hot temperatu - wilt- the hot holding of all potentially hazardous foods above <br />on 5°F: <br />Mir ' <br />E'a ° <br />IIE <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 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br />END 16-02 Page 7o! 11 TEMP EVENT APP <br />06/19/19 <br />)° Ye 0 <br />Phone: 5-1 56 6 <br />p stove <br />ble steamer <br />lectric stove top