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SANACUIN <br />REC-008 <br />Envftonrneita HeaQh Department <br /> <br />COUNT) — <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. <br />Music in the 1.Name of Event: Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: 1 (r1 a,. V\ Al fITS':' Co L.L.C, <br />Address: 320 J.1 C-f\e N-von-\,- Vi-v,E, . ‘1---k0,0 \-f cc.- LAN otS3 ) ,-, <br />Phone: fr-OCA ' als - 3-IL-As') Alternate: 0_0(4 tA 7.10- <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:I '/Yes <br />All food is prepared on-site or is from approved commercial facililies:LJYe <br />Name of facility: Phone: <br />Address of facility: <br /> <br />5, I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />F <br />:u and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />liq <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 />FIDther (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 /> <br />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />1-4pproved bottled water. <br />Dn-site hose bib that is connected to a potable water source. <br />ther (specify): <br />asure the hot and cold holding of potentially hazardous <br />o the hot holding of all potentially hazardous foods above <br />9-21-24 <br />7. PD ecticrty is provided for my booth's use IYe: <br />S. I am providing an accurate probe therm v <br />foods during all times of booth operation Ye <br />9. I am providing the following hot temperature-Tont <br />amp stove Sterno & hotel trays <br />ouble steamer ''lleam table & lids <br />1•••••••••111 <br />lectric stove top 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. Hazefton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EVID 15.02 Page 7 of 11 TEMP EVENT APP <br />05/19119