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SA N J OAQ U I N Environmental Health Department <br /> COUNTY— <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 this event. <br /> 1. 1.Name of Event: A A L0Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/busi ss: ( 9 1AA Ci�b <br /> Address: (�t,1i bvit.. <br /> Phone: ( �` ) 0 1 - Alternate: { ) <br /> 3. List food to be sold or-given to the public:&A.IVAek )S. Ccink, crs.Z� <br /> 61vi r,C', i <�, <br /> 4. 1 am providing food that is NOT prepared at home: ❑Yes [9 No <br /> All food is prepare n-site or is from approved comet rcial facilities: Q Yes ❑ No yy <br /> Name of facility: <br /> Address of facility: C9 C <br /> 5. 1 am providing a booth with the following: (to protect my unp ckaged 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 /> Other(specify):im <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 /> El Other(specify): �JG� L�-l`ew WA 5 <br /> 7. Electricity is provided fo my booth's use: ❑ Yes 4 No : <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes FA 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 ❑ Stemo& 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 E F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06/19/19 <br />