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r in auiiJ�;• SAN JDAQUIN <br /> ` -�"_• ��.• Environlrnernta! Health Department <br /> " LCdUNTY <br /> -4r,.+ruP>rY"- Greatness grows f�er�. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(bath 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 /> 9. <br /> 1.Name of Event: <br /> 2; The following is Information about my arganization/business: N <br /> Name of organlzalionlbuainess: SCJ/ax ti 1 <br /> 41 <br /> Address: <br /> Phone: (2oq) g f pO Z4<9 Alternate:( ) <br /> 3. List food to be sold or given to the publlc: <br /> 4. 1 aril providing food that is NOT prepared at home:A Yes❑No <br /> All food is prepared on-site or Is from approved coram,erelal facilities:M Yes ElNa <br /> Name of facility: 0L) 2122 f5 /��� ^.�� +� Phone:,(ZOY) 0ID Q I6 5 <br /> Addr6ss.of facility: � l/I� A VP LO !� r�/�' 9 S 2' <br /> 5. 1 am providing a booth with the follpwing:(to prosect my unpackaged food and food-preparation areas from files, <br /> dust and the public) <br /> A A booth With walls and ceiling constructed of either wood,:c'anvas, plastic,similar material and fine mesh fly <br /> screening, cot�npletaly ene]osing open Food ardas. 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 /> ❑Other(specify): <br /> Nota: The only operations not roquir;ed to provide enclosed booths.are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinhing,utensil and hand washing will be provided Irt my bobth by the following.rnefhods: <br /> JZ Approved bottled water. <br /> ]On-site hose bib that is connected to a potaNe.water source. <br /> [.]Qfher{specify): <br /> 7. Electricity is provided for my bodth'8 use:❑Yes M No <br /> B. l am providing an accurate probe thermometer to rhieasure'ttre hot and cold hold <br /> ipg of potentially hazardous <br /> foods during all times of booth Operation: Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of at <br /> potentially hazardous foods ab6vo <br /> 135°F: <br /> (]Comp stove ❑Sterno&hotel trays <br /> J]Double steamer ❑Stashi table&lids 9 <br /> ElFlecftic stove top --EI'Mor?specify) f 1^a 1 QA Q <br /> Note: l;Xatpplos of potentially hazardous food Include; Meats, tamales, coofted beaks; rice, <br /> Vegetables,potato salad,eggs,-a6d"dairy products. <br /> i <br /> 186E3 E. Hazelton Avenue l Stockton,California 9521?5 l T 209 468-342Q l >= 209 45.4- 138 1 www.sJcehd.com <br /> EHE 16-02 Raga 7 of 11 TEMP EVFNT APP <br /> 0713/17 <br />