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SN� �QQfN a <br /> Enviranmerrta� �iea�t� Department <br /> s <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> V bashmW wor�ndm:"WOEAM pry to tft WAf t_ <br /> 1. 1.1+katrsecsfEv.� : Webet•sto�vn Fat rner•s Market _ .):St[ndays Apr-Apr <br /> 2. The following is information about my organ izationlbusiness: <br /> Larne of organizationfbusiness: t Imrvi �a ve_ � <br /> Address: t f0 f • J✓ - .Sin L orflct'a'_ _ <br /> Aftinatw <br /> 3.. List food to be sold or given to the public: 4 1 tA�1MM t±S. 10 Li c < t2;1,2 5 Grl r) -LC, 21 c) <br /> 4. 1 am providing food that is No prepared at home, ❑Yes [3- o <br /> All food is prepared on-site or is from approved commercial facilities: Yes❑ No <br /> Name rg tardy: jt :.4r n-��.� S t c�U ��. _ Phone` (191-5-) 1-?8 G P <br /> Address of faciiTtr. _ !? O t7 o i-tt 4 -•s,�Cn L e cYrr fr o �'J — <br /> 5. 1 am pravidnq a booth with the following (to protect my ungixkaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A 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 foor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> xaaVs true the M-A*c- p / <br /> 17 Omer <br /> Nola- The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sournes. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the folowing methods: <br /> �]A4p9mved boftial rester. <br /> �] On-site hose bib that is connected to a potable vrater source. <br /> AJ <br /> ❑Other(specify , ' <br /> 7. Electricity is provided for my booth's use: ❑Yes❑ No <br /> 8, 1 am providing an accurate probe thermomeber io measure the hot and cold holding of potentially hazardous <br /> toodsduring au times of booth operation: Ll Yes❑No <br /> S. 1 am providing the 631 a hot temperature ox tml for the knot hoidk�g of as polerdiatty t%azatdmis foods above <br /> t35"F: <br /> Q Cam¢stove []stexno&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove by ❑ Other(specify) <br /> Note. Exzmples of potentially hwrdous tood include_ meals, tamales, zooked baan-s, rice, <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 4 T 209 468-3420� f 2D9 464-10138 I www.sjcehd.com <br /> tH@ lf,4)1 Page 7 of 19 TFMV EVENT APP <br /> 07f3M <br />