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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Name of organization/business: <br />completed copy of this checkJsUo, <br />(-Sio ) __________ <br />-COUNTY------ <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br />Q Steam table & lids <br />Other (specify) <br />are those which sell beverages fromNote: The only operations not required to provide enclosed booths <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 />[^Approved bottled water. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjg^rg/ehd^ <br />EHD 16-02 Page 7 of 11 <br />06/29/2023 <br /> Other (specify):_____________________/.--------------------------------------------------------------------------------------- <br />Electricity is provided for my booth’s use: Yes 0 No <br />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: 0 Yes No <br />I am | <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes pNo <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: <br />Address of facility: w- ■ » <br />All food vendors (both for profit and non-profit) are required to return a signed and <br />the festival coordinator three weeks.prior to t^iif event. <br />1. Name of Event: ---------------------------- <br />The following is information about my organization/business: <br />*7~r t, pc 6 a 6 li, -------------------- <br />yfGr_,ktrif. f QA '(5 2) (1 <br /> Alternate: (5< & ) 5 20 27 2 <br />......... [UfYes No <br />Ut-ep RvJ- Huh Phone: ( )______________________ <br />____________-------------------------------------------------------------------------------------------------------------------------- <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 />E/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.