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S A N -J U A Q U I N Environmental Health Department k OUNTY -- Greoiness grows here. TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and compiated copy of this checklist to the fostival coordinator three (3) weeks prior to this event. 1, 1,Name of Event: k(1 1 � �� T_._ Dale(s): 2. The following Is information about my organlzatlon/business: Name of organizallon/busin tre-ss,: " " YL:k,A�� v a�; 2)VX0- J � Address: �� ISTA_ *V Cj- ( QJ c�� L/1 .+' ` L( a Phone: ( ) A01 -I JZ- l Alternate: ( fo) 3. List food to be sold or given to the public: GkkV6 —v-U, RA 4, 1 am providing food that Is NOT prepared at home: KYes ❑ No All food is prepared on-site or Is from approved commercial facilities: ❑ Yes ❑ No Name of facility: Phone:.( a 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) Pi A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly s r ening, completely enc€osing 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 fallowing methods: approved bottled water. ❑ On-site hose bib that is connected to a potable water source. ❑ Other(specify): 7. Electricity is provided for my booth's use: Yes ❑ No t3. I am providing an accurate probe thermcgnb i�r to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes ❑ No 9. 1 am providing the following hot temperature c ntrol 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 NOther(specify) Note: Examples of potentially Nazar ood In lude: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. i stia E Viam ton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slgov.orp ohd I II[N It.a.' Pago T of I 1 TEW E%CNT APV nr 0! AV4