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SAN JOAQUIN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPUCATiON <br /> All food vendors(both for profit and nw-prW,,)are required to return a signed and completed copy of this chcckhst to <br /> the festival coordirritor throe(3)weeks prior to this event <br /> 1.Narme of Ever: <br /> 2. Th0 toIkw4W is information a bout rny, car--nizatioQ b—u-sirT—ess. <br /> Name of organizatioNbusin <br /> Phone. OA) _V- "\ Allternate- ) <br /> 3. List food to be sold or given to the pLt4iccma , -� !• , �� <br /> 4. 1 am providing food that is NOT prepared.at homelGes No <br /> All food is prepared on-site or is from approved c nimercial facjfies,)<Yoss C7 No <br /> Name of facility, Phone: <br /> Address of facd* <br /> 5- 1 am providing a booth with the fotlmvje :(to pion my unpac kaged food and food-preparation areas from flies. <br /> drat and the pubfrc) <br /> ❑A booth with watts and cci"comtructed of eitheT wood, canvas,plastic,similar material and fine mash fly <br /> screwing, completely enclosing open food areas. it will also have r3 smooth and oleortahle floor (concrete, <br /> asphalt, clears taps and smooth wood am aoceplable)and constructed to separate food and food preparation <br /> areas from the publ' <br /> Other(��). 1`l Wal dG<- <br /> tote: The enty operations ruX required to provide inclosed booft are she.^.o which ee bovcragm from <br /> approved dispensers,or prepackaged foods fmn approved strums. <br /> 6. Approved water for Wrikino,utensil and hand wastring will be provided in my boolh by the following methods <br /> ❑Approved bcdled orator. <br /> on-site loose bb that is comected to a potable water source. <br /> 0 Other(specify): <br /> 7 Eloctricity is provided for my booth"s use. Yes[]No <br /> 8 1 am providing an accurate prone therrnomet to measure the hot arod cold holding of potentially hazardous <br /> foods during all tines of booth operation; Yes❑No <br /> 9. 1 am providing the following hat tesrrpera;ufe control for the hot holding of all potentially hazardous foods ate <br /> 135°lr: <br /> ❑camp stone ©Sterno&hotel trays <br /> -010ovble steamer 0 Steam t,0--&lids <br /> Clectric stove top ❑Other(specify) <br /> Note: ExarxV1cs of ;potentially hazardous food include: rneats, tamales, cooked beams, rice, <br /> vegetables,potato salad,eggs,and dairy products, <br /> 1855 E HaZORW Avenue it Stockton" Calrramia 9520-5 1 T 209 468-34201 P 209 464-0135 ) uw+ :Ngov nrolbad <br /> Ez-n M2 Pale:of 4: <br /> r�r 'TEMP i VENI APn_ryn4 <br />