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Date(s): <br />5. <br /> <br />SAN <br />FMVir^OMENTAL HEALT.-Oc?ns <br />1868 East Hazelton Avenue, Stockton, Cnliformn <br />Business: (209)468-3420 _ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) arc required to return a signed and complete PY <br />checklist »C> thv festival CGOrdiliuiGi tiuCC ACCKS prior iG iniS vvCm. <br />1. Name of Event: Date(s):---------- ------------------- <br />2. The following i<mformation about my organization/business: <br />Name of organizationTbosinn^ Z-l ---------f-------- <br /> Address: O /? S - <br />?h0=: —^7- <br />3. List foo^to be'^old or given to the public: /f? > Zy -7^ _> <br /> <br />----------------- <br />4. I am providing food tfiat isflO'^prepared at home: Q/fVes [ ] No <br />All food is prepared on-site or is from approved commercial facilities: [Z/j r es [ ] No <br />Name of facility: 'n Phone: ■ <br />Address of facility: Z?- /^p <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />[ ] A booth with walls and ceiling constructed of cither wood, canvas, plastic, similar material and fine <br />mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. y f 7 yJ\ /')' <br />Other (specify): j L C(?C'^^l , f <br />Note: The only operations not required to provide enclosed booths arc those which s^ll belet^g^ 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 <br />methods: <br />[ ] Approved bottled water. <br />[ ] On-site hose bib that is connected to a potable watcpsourco- / <br />M) Other (specify): (ft bJ(? Llt^ <br />7. Electricity is provided for my booth’s use: [ ] Yes tyft No <br />8. I am providing an accurate probe thermometer to measure the hot and cold holding^ notcn^ltTf^^^ . <br />foods during all time of booth operation: £/] Yes [ ] No I ('yJ <br />9. I am providing the following hot temperature control for the hot holding of all notentiaii r <br />above 135 degrees Fahrenheit: P nhally hazardous foods <br />[ ] Camp Stove [ ] Double steamer [ ] Electric stove ton <br />[ ] Stemo & hotel trays [ ] Steam table & lids [//f Other (specifvY / <br />Note: Examples of potentially hazardous food include: mpntc . y)'. <br />potato salad, eggs and dairy products.