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SAN JOAOUIN TEMPORARY FOOD VENDOR’S APPLICATION 1.Date(s): 2. Address: Phone: 3. 4. 5. those which sell beverages from 6. 9. 7. 8. Alternate: ( Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ^Other (specify): QWjCS Tf A \\C. _________ Note: The only operations not required to provide enclosed booths are approved dispensers, or prepackaged foods from approved sources. The following is information about my organization/business: Name of organization/business: SSO I 53)2- CraPKcmn ~ 1 ) List food to be sold or given to the public: 1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 I www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APR 06/29/2023 All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 1. Name of Event: Date(s): tfflAPMW) Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Other (specify): Electricity is provided for my booth’s useYes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: ^ Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove Sterno & hotel trays Double steamer Steam table & lids Electric stove top Jx^Other (specify) meats, tamales, cooked beans, rice, )__________________________ I am providing food that is NOT prepared at home: Yes Kj No 11 j All food is prepared on-site or is from approved commercial facilities: Yes No Name of facility: Phone: ( ) Address of facility:_________________________________________________________ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public)