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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s):1 <br />2 <br />Phone: <br />3 <br />4 <br />5. <br />6 <br />9 <br />moats, tamalos, cooked beans, rice, <br />TEMP EVENT AJ’P <br />7. <br />8 <br />SAN JOAQUIN <br />Approved water for drinking, utensil and hand washing will be provided in my booth by (he following methods: <br />■^fXpproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />0 Other (specify): jW! CK Zl V/M C ____________________________________ <br />Electricity is provided for my booth’s use JrpYes LJ No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation:^Yes No <br />* fo,,ow’n9 hot temperature control for the hot holding of all potentially hazardous foods above <br />I 1 Camp stove Q Sterno & hotel trays <br /> Double steamer Q steam table & lids <br />U Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) mo required Io return e signed end completed copy of this checklist to <br />(he festival coordinator three (3) weeks prior to this event . / <br />1 Name of EVent: Date(s): Vf <br />The following Is Information about my orgnnlzallon/buslness: <br />Name of ocgnniration/business: ,_T7J!l€.C <br />Address: -------- <br />/ Alternate: ( <br />Ust food to be sold or given to the public: fl/l# C ' K)' (£ 1^4 / <br />I am providing food that Is NOT prepared at home: O Yes (^ko <br />Aft food is prepared on-site or is from approved commercial facilities:'£39'es O No <br />Name of facility. / ^'Ik! > Phone: <br />Address of facility: H q $. [ I^U <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />0 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />^Other (specify): _____________________________________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />WE Hazelton Avenue | Stockton. California 95205 | T 209 468 3420 | F 209 464-0138 | www.sjgov.ofg/ehd <br />( »<0 t$-02 Pago 7 of (1 TE“.a S’.'EH <br />06/19/19