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S A N D OAQ U I En vall'o93m1rWcal Heats Depa invent <br /> - - C c)U N T Y--. <br /> TEMPORARY FOOD VENDOR'S APPUCATI ION <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)wee prior to s event c� <br /> 1. 1.Name of Event: Date($): _ <br /> 2. The following is information about my organizabonlbusiness: <br /> Name of organization/business: cif 3' <br /> 46 Uzi A/1G' <br /> Address: <br /> Phone: ( ��) � `? U/ Alternate:( ) <br /> 3. List food to be sold or given to the public: ����� <br /> f- <br /> 4. 1 am providing food that is NOT prepared at home:�Yes❑ No <br /> All food is prepared a -site,or is from ap roved c rnmercia facilitiesj&jYes❑No <br /> Name of tacil-rty. Phone:( 1 --- <br /> Address of facility: <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from fries, <br /> dust acid the pz-CEc) <br /> ❑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. /oeother(specify): �7 , t. <br /> 1 <br /> Note. The only operations not required to provide closed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6_ Approved water for drinking,utensif and hand washing wili be provided in my booth by the following methods: <br /> ❑Approved bottled water_ <br /> ❑On--&�—titer LE-tip-f-f to a po = r <br /> 0 D&er(SFecffy): <br /> 7. Eler bic'g is Qrovkled f37 my i u2vs Fes:❑Yes❑�ti'n <br /> 8- t aM prMa[MG an aCCLrM--'--P—M!--V:Iar Lw. g t3 nzaas.:sa WDa ixr and Cn—"d e: <br /> fish&=9 am tom, s c'_`• Yes❑NO <br /> 9- t an p7Cr.-5EFMa tt;e tof-sxsg hat ter:pela�lrm?Control:ar file:rest ai a3 pn�--'=' Y k—,-- -=s a a--mge <br /> 135"F: <br /> ❑Camp stove ❑Sterna&hotel trays <br /> ❑Double steamer ❑Steam table&fids <br /> Q Eti.�..sec s`ou--tcp 0 Oth^s( y) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue E Stockton,Califomia 952051 T 209 468-3420 1 F 209 464-0138 1 vAwr.*ehd.com <br /> EHD 1"2 Page 7 of 11 TEMP EVENT APP <br /> 0713117 <br />