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Environmental Health Department Z^-3/, 2aZSDate(s):1. 2. Phone: 3. 4. 5. 6. 9. meats, tamales, cooked beans, rice, 7. 8. Other (specify):_—--------------------------------------- Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. Ef Approved bottled water. _____________ Alternate: chicken SAN.JOAOUIN ------COUNTY------ Greotness crows here TEMPORARY FOOD VENDOR’S APPLICATION 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. I.Name of Event: Kii'ai-rr market foods during all times of booth operation: Yes No I am | 135°F: Camp stove Double steamer Electric stove top S3 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. The following is information about my organization/business: Name of organization/business: A/^7 V /Z^A-/ U M Address: Z/g.^S 'Rd. J^di Cft () QQP 7 Alternate: () <3 ' 'Z S' 3>3 List food to be sold or given to the public: On-site hose bib that is connected to a potable water source. Other (specify):_ ___ ______________________________ ____ Electricity is provided for my booth’s use: [3 Yes No I am providing an accurate probe^thermometer tonneasure the hot and cold holding of potentially hazardous providing the following hot temperaturrcontrol for the hot holding of all potentially hazardous foods above Stemo & hotel trays Steam table & lids pother (specify) Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. 1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov org/ehd^ EHD 16-02 ■ Page 7 of 11 nR/oo/onoi .> S’ I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: Yes No Name of facility: Id Phone: (2^^) (R-------- Address of faci I it y: -— I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public)