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SAN J0A0UIN Environmental Health Department <br /> _ ----cnijN 3 Y--- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to natum a signed and compk4ed copy of this chocttiist to <br /> the festival cDwdinatoTttuae(3)weeks prior to this event. r <br /> 1. 1.Nam of Event, �-0(� . tj�c r`C c -UAA, Dates}: i 3 �Flo <br /> 2 The foitoywing is information about my orgahtzatfoWbusiness. <br /> !Marne of wgarazatmnfb4sines5: <br /> Address: <br /> Phone; Altera te_( } <br /> 3. Ust food to be amid or given to the public- <br /> 4, <br /> ublic4. 1 ern providing food that Is HOT prepared at home.[, Yes 0 No <br /> All food is prepared onsite or is from approved commercial facilities:QrYes 0 No <br /> Name of farmer (--,,) _-N�j f DIA l i 3 9: ,a+�.8 <br /> Address of fao3A.y: 10\ �t�r Sti_ grafi, Ltd tL F <br /> 5. 1 ant prang a booth with the fotfowing:(to probed my unpaduiged food and food-preparation antes from flies, <br /> c- dust and#W pc,lic) <br /> r <br /> '----ET—A—booffi vridi vv=alis and Gtit6ttg corr„inxiedvf vrlfter-wood,canvris,ta"c,simitar.matifflol and fine nu3stt fly <br /> t QVW,ng,0ompt03ty enclosing open Coat areas, it wilt at-.Q have a smooth and cfeaYi&Ibfe rKxW Itrorir me <br /> asphalt,clean tarps and smooth ve'od are&Mepteble)and cormtrucfed to separate food and food prapinatfon <br /> areas from the public. <br /> ❑Other{ }: <br /> i <br /> Note: The only operation not required to pmvido eock sed booths are thase which sell beverages from <br /> approved dispensers,or pr©pac*e d too -hum app rovad souraas- <br /> �1 P� 6. Approved water for drhr+ung,L&-ns!1 and hand washing witf ba pmvided in my booth by the foNowtN moux cls: <br /> Q Appn wed twtlded water. <br /> 0 On-,sita hose bib that is connected to a potabta water source. <br /> ©Othof(specify): <br /> l� r. Efacuidty W provided for my booth's use:0 Ye ❑No — <br /> U & I am prnvidtng an a-mmate probe thunnometer to mesasum the hat and tutd hot Vng of"n1juny hawrdom <br /> too&during nti timed of tooth op"allon:0 Yes 0 No <br /> N A 9. 1 am;=YMing tfaa folkminq hul temperature cxv*t)l far the hot tu+Shcng pf alt potonUally hazardous foods above <br /> 0 Camp stove ©Stamo&hotel trays . <br /> ❑Doublu 5tt-weer 0 Steers tat-4a&Mir, <br /> 0 Llra r stove top ❑Other(Sp oAy) <br /> Nota: Exarnppas of potar>tWly hazardous food Include: rn"ts, tamales, cooked beans,'rke&, <br /> vagritebtaa,pc4ato aab4 egpa,and dalry products - <br /> 1868.4 Hazetton Avenue Stockton,California 952051 T 206 468-3420 1 F 209,464-0134tvww,sjQav,org ehd <br /> FNO 1842 r'eYu Tor 77 <br />