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Environmemtsiil H©afth D«pah:rcaovjk <br />; <br /> <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event;1. <br />2. <br />Address: <br />) Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />8. <br />9. <br />TEMP EVENT APP <br />0 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. . ; <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />------COUNTY- <br />' LC.jrf-v209-585-8961 <br />22-54-i-aek-sofT-ave^seaionh0'al9532f—-------- <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 . ' TEMP EVEN! <br />07/3/17 ; : •••?•.••••• <br /> Other (specify)::,__________ <br />7r'■ Electricity is provided for my booth's use:-A Yes F7l No • • ’ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />LJ Camp stove <br /> Double steamer <br /> Electric stove top <br />are required to return a signed and completed copy of this checklist to <br />the feshval'co^^i'nator three (3) weeks priorto this event. <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is preparecn^ita^ti^frtpacwouedcQ^wmaL^ilkie^ <br />Name of facility: *“A ' - 1 ’ <br />Address of facility:. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />Alternate: ( <br />Baked goods <br />meats, tamales, cooked beans, rice, <br />The following is information abouj^yo^pn^t B^kOTy <br />Name of organization/business:_T------------------------------------------ <br />2251 jckson ave ,escalon ca95320 <br />^0^585^8961 <br />All food vendors (both for profit and non-profit) <br />Lodi farmers market 4 SJmJ' F^iKoatetsy.