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S A N J O AH I N Environmental Heal-h.Healt-h. Department TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three (3)weeks prior to this event. 1. 1.Name of Event: -3 V1 rar i - bate(s):`� J1S91Z',3 2 The following is information about my organ¢ationrbusrness- Name of arganizationlbusiness: 2 ! �>r Address: C 25 3 3 Phone: ( L't� ? W Alternate: ( 0`f; �� '7gZ 66,r-&v,) 3. List food to be sold or given to the public t 7c� 'y'YY�d r Yl �5 �� '`ate _r_Y1_p e,51ice-S 4. 1 am providing food that is NOT prepared at home: Yes ❑ No All food is prepared on-site or is from approved commercial facilities:W Yes[] No Name of facility: Phone: 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) ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing 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): s�Bf7 � ts � -e- i s e ct r-pi 'tc-1 14 ..ram- D Note: The only operations not required to provide enclosed booths are � -e- wFrich sell beverages from approved dispensers, or prepackaged foods from approved sources. %s. Approved water for dnnkinr, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Other(specify): f' ,,ud w6,4 i sJa4 t-j-)4 7. Electricity is provided for my booth's use: C Yes Y�No 8. l am providing an accurate probe thermometer to measure` the hot and cold holding of potentially hazardous foods during all times of booth operation: ❑Yes❑ No Nf .A 9. 1 am providing the following hot temperature control for the het holding of all potentially hazardous foods above 135-F Camp stove ❑Stemo& hotel trays ❑ Double steamer ❑Steam table&lids 1j1A EW Electrtc stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. 1868 E. Nazellon Avenue I Stockton. California T 2a,468-3420 1 F 209 454-0138 ) www sjcehdcorr. EHD 16.02 Pago 7 Cr 11 TEMP EVENT APR OM47