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» <br />1. <br />2. <br />Address:1- <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 />O On-site hose bib that is connected to a potable water source. <br />meats, tamales, cooked beans, rice, <br />6 <br />Cl <br />■i <br />' U K 11TJ V H 9 V I H <br />-----COUNTY— <br />Grcrtfin-sss qroiv;? here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Electricity is provided for my booth’s use: Yes IHNo <br />I ____o ___ . . <br />foods during all times of booth operation: Q Yes Q No <br />I am | <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Q Other (specify)::------------------------------------------------------------------- <br />Electricity is provided for my booth’s use: Yes IH No . <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />providing "fotowing" Mte^Sur^ontro^r me hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />; 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 />O^pproved bottled water. <br />1868 E. Hazelton Avenue ( Stockton, California 95205 | T 209 468-3420} F 209 464-0138 | www-sj^^o^^pp <br />EHD 16-02 Page 7 of 11 <br />06/29/2023 <br />7. <br />8. <br />All food vendors (both far 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 />f.Name of Event KIVER ISlAMOS CFM_____________________Date(s): ^Zl- <br />J p ____________ <br />Alternate: (51 ^7^^^ <br />The following is information about my organization/business: <br />Name of organization/business: 'Psy Clfl $_ <br />I M (' A o <br />_________ <br />List food to be sold or given to the public:_________ <br />I am providing food that is NOT prepared at home: [^Yes O No <br />All food is prepared on-site or is from approved commercial facilities: EZpYes No <br />Name of facility: jp -rCy c/7 ? [/}----------------Phone: ^3 3^ -------SI---------- <br />Address of facility: ^^*7 A-H^Y / CA ----------------------—------------— <br />I am providing a booth with the following: (to protect my tfnpackaged food andTood-preparation areas from flies, <br />dust and the public) <br />(3^ booth with walls and ceiling constructed of either wood, canvas, plastic, similar 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.