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%.. ■ <br />I.Name of Event1. <br />2. <br />I 7 <br />) Phone: <br />lVz<V\ vl f3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> Approved hotted water. <br />t*'. <br />meats, tamales, cooked beans, rice, <br />Name of facility: <br />Address of facility: <br />f. <br />vniw vn w v mi .................. <br />------COUNTY------ <br />Greeitness gro'.vs hs-rf. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />are those which sell beverages from <br />sources. ~~ <br />All food vendors (both for profit and non-profit) are <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />RIVER ISLAMAS (jFM <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgo^eh^ <br />EHD 16-02 PageTofU <br />06/29/2023 <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): _________________________—---------------------- <br />7. Electricity is provided for my booth’s use: Yes No <br />8. ! ai’l 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 No <br />9?* I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF: <br />I | Camp stove O Stemo & hotel trays <br />|~~] Double steamer l~~l Steam table & lids <br /> Electric stove top D Other (specify) <br />Date(s): ^^7 “ <br />The following is information about my organization/business: <br />Name of organization/businessA/t/ ------------ <br />-y.-J.-Vt (Dr, <br /><1 ) ...Alternate: ( <br />List food to be sold or given to the public: /—fit r ( ---------------------------------------- <br />I am providing food that is NOT prepared at home: 0*^s EJ No <br />All food is prepared on-site or is from approved commercial facilities: Yes No / / *) < <br />_ _______Phone: ) ? ^ 2 - S ..J------- <br /> Address of facility:_______l ^7 Q Q-J7[ k U— — <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dustpnd the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely endosing 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.