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!�{ 4 i Go- r�Y I � S A N J 0 Q U I N EnviYomrnent a� Fitsafth Depultmali At _•1• TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and nor-profit)are required to return a signed and completed copy of this checidist to the festival coordinator three((3)weeks prior to this event 1. i.Nam a of Event [ rcekt Ic— Date(s); 3 54 2 The following is information about my organization/business: to Y3 l' Name of organization/business: -e S S Address: 6 10 1 Phone: ( A7) � — 3— _ Alternate: { ) 3. List food to be sold or given to the public: Bcg�hGh 4. 1 am providing food that is NOT prepared at home: ❑Yes D'11;ro All food is prepared on-site or is from approved commercial facilities:2Yes❑No Name of facility_ � Phone:i -07l _�_�6 —a-o l Y_ Address of facility._ _ c _ lit :� } La IA , r_�- � �U_ Fa k�3 I� 5- 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with walls and veiling 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): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepa*Wect foods from approved sources. 6. 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): 7. Electricity is provided for my booth's use:❑Yes❑No $- I am proovlding an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:❑Yes❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135`F: ❑Camp stave ❑Sterno&hotel trays ❑Double steamer ❑Steam table&lids ❑Electric stove top ❑Other(specify) Note: Examples of potentially hazardous ♦load include: meats, tamales, cooked beans, rice, vagedables,potato sated,eggs,and dairy products. 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjgov.org/ehd EHD i&M peps 7 of i i TEMP EVENT APp �ri��o