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S A N J O A Q U I N Environmental Health Department <br /> ----C O U N T Y-- <br /> --'' r <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 /> the festival coordinator three(3)weeks prior to this event. .1 jNe 6-, 1Ai /�, d� <br /> _ J j�p 3, /o, 17, Z y 3 <br /> 1. 1.Name of Event: /�� L« r�ti VmN�2 i11���ket Date(s): J <br /> 2. The following is information about mrylorganizzaat_ion/business: ` �( L l <br /> Name of organization/business: 1l l ta-C V�O�i.`�S c\� l ale H l� IH <br /> Address: <br /> Phone: (�U`( ) 6 3 -b7U-? T� Alternate: ()6't ) (IS -6 T D 7 <br /> 3. List food to be sold or given to the public: K� l< <br /> 4. 1 am providing food that is NOT prepared at home: M Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: I9I Yes U No <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> A booth with walls and ceiling constructed <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 07/3/17 <br />