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TEMPORARY FOOD VENDOR'S APPLICATION AlI food vendors (both for profit and non-profit)aro required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event ' - 'l. Dates : 1. 1.l�ame n#Event �n,b . �,.,�v�_j r_ r.E't ( ? .� l 2. The following is information about my organ ization)business: Name of organi7ationrhusiness:, Y2 cl?W Sbtt t kc,I-r Address: a Phone: QIt, )--� 014-f-14 _ Alternate: ( ) 3. List food to be sold or given to the public: P►,'1;-_y� i ��: i :-, =f> ' � ,f; 1€�c� �Wt e - T-0 r5 4. 1 am providing food that is NOT prepared at home: ®Yes [] No All food is prepared on-site or is from approved commorcial facilities: [ Yes No Name of facility H r:_ i+, tit,, Phone: cl;L [ 4-eW i- Address of facility t'i� [,��c�.t 1 ,;G i. iiCs.srT c:x + C I�- f ,,'- ' 5. 1 am providing a booth with the following: (to protect my un ackaged food and food-preparation areas from {ties. dust and the public) l;%kCi: I"11u ,i ❑ 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) r�-- -- — — C.: Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources 6. Approved water for drinking, utensil and hand washing will be provided in my booth by tho following methods: ( Approved bottled water. [� on-site Dose bib that is connected to a potable water source. ❑ Other (specify)- 7 Electricity is provided for my booth's use: W Yes[] No 9- 1 am providing an accwale probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: W] Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above '[35"F- ❑Camp stove ❑Sterno&hotel trays Double steamer Steam table &lids �] Elmtric stove top 0 Other(specify) -e£ryk Qa,tot+' Note. Examples of potentially hazardous Food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. 1868 E. tfazelton Avenue 1 Stockton, California 95205 1 T 209 463-3420 1 F 209 464-0138 1 w%w.sjcgov.orglehd DID 16 02 P aLp 7 0 11 11 FAP E V ENT APP OV-.9l19