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PH <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1. <br />The following is information about my organizatiorVbusiness:2. <br />X2_Z^ <br />Ng.Address: <br />Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />5. <br /> Other (specify): <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />(^Approved bottled water. <br />@[ On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <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 /> Stemo & hotel trays <br /> Steam table & lids <br />O Other (specify) <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------ <br />Environmental Health Department <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />OTV-VIt”02 Page 7 of 11 TEMP EVENT APP <br /> <br /> <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />riA bootfi 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 />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) weeks prior to this event ; <br />Date(s): <br />Name of organization/business: <br />7^.7-^3^ Alternate: <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: [/(Yes No <br />Name of facility. J^/^^hone: <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 /> Other (specify):________________________ ____________________________ <br />Electricity is provided for my booth's use: Yes No <br />1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: K Yes No <br />1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />QCamp stove <br />[^Double steamer <br /> Electric stove top