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S A N J O A Q U l N Environmental Health Department <br /> COUNTY <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and nonprofit) 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 /> 1. 1.Name of Event: Sf `epJF 1CJo.,�� _ Date(s): 2 <br /> 2. The following is information about my <br /> organizationlbusiness: <br /> Name of organiz `� <br /> +ationlbusiness: wc kL Q, <br /> Address: l l /y M Qvt S-76 C <br /> Phone: ( (p )J 2-s-,X(o Alternate: ( ) <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home: U14yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: N'Yes ❑ No <br /> Name of facility: Con�muV1 '4 Jf, \ Phone: ( ) �� Z 10q <br /> Address of facility: C) f DUr0�h Sr 5SD Z <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 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 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 /> W Other(specify): Fod i-Vt�-:(V <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other (specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes KNo <br /> S. I am providing an accurate probe thermom6er to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: V\1 Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove RSterno & 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,sjgov.orglehd <br /> EH❑16-02 Page 7 of 11 TEMP EVENT APP <br /> 08110!19 <br />