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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event1. <br />2. <br />Name of organization/business: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths <br />6. <br />meats, tamales, cooked beans, rice, <br />or\ep s <br />The following is information about my organization/business: <br />UMH J vm y V I I ’ <br />— COUNTV----- <br />JSST: <br />S Camp stove <br />O Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />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 />1868 E Hazelton Avenue I Stockton, California 95205 j T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EdD5S4)2 . PageTofll TEMP EVENT APR <br />0S/29/2Q23 ___ _ <br />7. <br />8. <br />9* <br />• <br /> Other (specify):- ... <br />Electricity is provided for my booth’s use: Q Yes jisJ'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 Q No <br />1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & Bds <br /> Other (specify) <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 />iSLAftlQS CJFM________________Date(s): <br /> Alternate: ((-SO) - <br />List food to be sold or given to the public: C Ckg£.X( <br />T^cckAAi -aCkUR, O-orilO <br />I am providing food that is NOT prepared at home; .KfYes [J No <br />All food is prepared on-site or is from approved commercial facilities: O Yes O No <br />Name of facility. _Phone: (-----1— --------------------------— <br />Address of facility:.____________ _______"S > Vg--------------------------------------- ---------------- ----- ----- <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) o f «JYX -AttaJ cJ<L_ <2- 4-4^ p rvA l-| <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, simflar 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 />Address: