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S A N J Q A D f N Environmental Health Department 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. 1. 1.Name of Event: QA b1Z 1. /b,, /,( f"n�/AA r" Date(s): Irk 1'1 l-r)-,JD S 2. The following is information about my organization/business: Name of organization/business: , t n C 0{ I rill 8q- JL a9a r . tRl�n)r=r>r . ICJ, Address: P F l Phone: ( kel )^11 ) as3 Alternate: ( _)O/ 1 _'7tj5 - In`; _ 3. List food to be sold or given to the public: (r r,)i-j i,i Fi fh,r l�l:[,� /-i Sh [.nl 1!Fn 4. 1 am providing food that is NOT prepared at home: ❑Yes ❑ No All food is prepared on-site or is from approved commercial facilities:0 Yes ❑No Name of facility: Phone: { l Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) M 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): 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 the following methods: ❑Approved bottled water. ❑ On-site hose bib that is connected to a potable water source- El Other(specify): 7- Electricity is provided for my booth's use:E] Yes❑ No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: [A Yes ❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑ Camp stove ❑Sterno&hotel trays ❑ Double steamer ❑ Steam table&lids ❑ Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 ] wvvw.sjgov.org/chd EHO 16-02 Page 7 of 11 TEMP EVENT APP 07101=24