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4113/26.3:49 PM ywepmm9txowftjf9cwyh.jpg(3024x4032) SAN JOAQUIN Environmental Health Department TEMPORARY FOOD VENDOR'S APPLICATION Ail food vendors(both for profit and port-profit)aro required to retum a s'.gned and comp:otod copy of this ct eck?ist to the festival ccurdinator three(3O( weeks prier to this event 1, 1.Name of Evert:AP.�1i J e,\ � - _Date(s): s 3 2. The fo!fovjing Is Information about my orpaniaatlonlbuslness: Name of organfzationfiusiness: Address: S QT - O Phore: (a011 ) 6 a-911-- Alternate:( } 3. List food to be sold or given to the public; 4ti 4n r -L fr 4. 1 am providing food that Is NOT prepared at home:❑Yes PTNo All food is prepared on-site or Is from approved commercial facilities:LTV.❑No Name of facility: e Phone:.42-1 1) Ci Address of facll,iy: y- 10 CS 5. f am providing a booth with the fnl!owing:(to protect my unpackaged food and food-preparation areas from flies, dust and tha public) ❑A booth with walls and ceiling constructed of either wood,canvas,plastic,s#miler material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor(concrete, asphal( clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation areas fram the public. ❑Other(specify): Nate: The only operations not required to provide enclosed booths are those which sell beverages from _ - approved dispensers,or prepackaged foods from approved sources. 19. Approved water for drinking,utensfl and hand washing wilt be provided in my booth by the following methods: ❑Approved bottled water. ❑On-site hose bib that Is connected to a potabta water source, ❑other(Specify): 7. Electricity Is provided for my booth's use:Lj Yes❑No 8, 1 am providing an accurate prate thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:❑Yes❑No 9. 1 am proViding tate following hot temperature control for the hot holding of all potentially hazardous foods above ❑Camp stove -]Stemo&hotel trays ❑Double steamer ❑Steam table&lids j ❑EteCtit stove top ❑Other(specify) — c Nate. Examples of potentially hazardous food Include: meats;,; tamafss, aooksd beans, rice, E vsgetrables,potato salad,sags,and dairy"ptoduats. 1868 E. Hazelton Avenue I Stockton,California 952051 T 209 466-34201 IF 249 46"138 ( www.sjgov.orglehd . TEMP EVENT APP https:i/res.cloucif nary.comico nventionforr,e/fmagetuploadtvl 768173197/ywepmm9txowft)Mcwyh.jpg