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S A N J OA Q U I N Environmental Health Department -- C0Ur.lTY--- farc groo. Kerr TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: " MiLl it s � CC V dJ Date(s): 2. The following is information about my organ izationlbusiness: Name of organizationfbusiness}:: P f �t� ! r'�•s9�f/ 44 L Address: cc+�4 '/P � r a. G J �� Phone: (�tiD) 3 q 2- `'ar a 5 Alternate:( 710 �'� - �3 hu r+.aw 5 'cr&01 3. List food to be gold or give E public: J 4. I am providing food that i OT prep Red at'h me: Yes -]No Ah food is prepared on-site or is from approved commercial facilities: V Yes❑No Name of facility: Phone: - C Q -4q3 Address of facility c a., Y 5. 1 am providing a booth with the following:(to protect my unpackaged food and Food-prepay tion areas from flies, dust and the public) ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphatt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Bother(specify): 0 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. L 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. El On-site hose bib that is connected to a potable water source. tL�I ( Other(specify): � r J 4 7. Electricity is provided for my h's use:❑Yes U No 8. 1 am providing an accurate probe thermomet r to measure ll hethot and col hording of potentially hazardous 4 foods during all times of booth operation:[VYes❑ No f 9. 1 am providing the following hot temperature control for the hot holdirfg-ot a tentially hazardous foods above 135"F: ❑Camp stove ❑Stemo&hotel trays ❑Double steamer Steam table&lids ` �P t� ❑Electric stove top Other(specify) 'U 1! �(•( r r� Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org'ehd EHO 1"o Pago 7 of 11 TEMP EVENT APP M19f19