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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. <br />2 <br />Address: <br />3 <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY—- <br />1868 E. Hazelton Avenue I Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | wwwsjgov.org/ehd <br />EHD 16-02 Pcge 7 of 11 TEMP E'.'ENT Af <br />06/19/10 ............................................. ...........................................--- iiii.. | hi <br />135T: <br />0 Camp stove <br /> Double steamer <br />^Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />O Other (specify):_ _—--------------------- - --------------------------------------------------------- <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 />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 />MowerM: F ____________ <br />Electricity is provided for my booth's use: Q Yes Q No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operalion^MYes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />O Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <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. . . <br />,. Name of Even,; til AtlHMZf | |2| BH1 SW ^1/ _ Me(s): MM <br />The following is information about my organization/business: <br />Name of organization/business: ^u&h IbfffrljtS <br />Phone ( Alternate: Lf----------- <br />bst food to be sold or given to the pubHc; 1111111 WM , <br />I am providing food that is NOT prepared at home; Yes No <br />All food is prepare^msifJor is from approved commercial facilities:^Yes No <br />Name of facility: ______________— Phone: (-------)--------------------------------------- <br />Address of facility: _____________— -------------------------------------------------------------------- - <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />k] 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.