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S A N J O A Q U I N Envil-olimental Health Department <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. `},/`1.UL4 (,�.,zicos <br /> f <br /> �. .Name of Event: ❑ate lsj - <br /> 2. The follow ng is informat?on about my organ'zationlbusiness: <br /> Name of oril <br /> on,business: - - <br /> Address: <br /> Phone: Alternate <br /> 3. List food to be sold or given to the public: ,/ <br /> 4. 1 am providing food that is NOT prepared at horme: ❑Yes iLi No <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yes Q'No <br /> Name of facility: Phone: ] <br /> Address of facility; <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flees, <br /> dust and the public) <br /> El A booth with wal4s and ceiling constructed of either wood, canvas, plastic, similar material arm `-e <br /> screenir:p, completely enclosing open food areas. It will also have a smooth and cleanable <br /> asphalt, ciean tarps and smooth wood are acceptable) and constructed to separate food and fccc =rec_-a:_- <br /> areas from the public. <br /> �ther(Specify): 4� <br /> Note. The only operations not required f provide enclosed booths are those which =e _c. <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved v.aterfor drinking, utensil and hand washing will be provided in my booth by the fat.•. _ _ <br /> ❑Approved bottled water. <br /> on-sre hose bib the Is connected to a potable water source. <br /> 21/other(sper,,fy) � <br /> 7. Electricity is provided for my booth's use ❑ Yes j,,.�o <br /> 8. 1 am providing an accurate probe therrr,omeler to hie•stare the hot find cold Iz110,,3 ,t pol3n,iall , .- _a �s <br /> foods during all times of booth operatiun: [I Yes o <br /> 9. 1 am providing the following hot temperature cunlrnl for the hot hald,ng of ail patelil3:jlly hazziruous foods above <br /> 135`F- <br /> LJ Camp stove ❑ sle'rlio b I,.:tel trays <br /> ❑Double steamer L_]Stearn & 11Lis <br /> ❑ Electric stove top U Othei <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 Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 wvvVW.sf oehd.Coni <br /> GJD1"2 Pa r7of i, PP <br /> 0=7 �- TEr.I Ia 'rrll AF'i' <br />