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I <br />9. <br />[ ] Stemo & hotel trays [ ] Steam table & lids <br />'-i;. <br />SAN JOAQUIN COiBtY <br />ENVIORMENTAL HEALTHDEPARTMENT <br />1868 East Hazelton Avenue, Stockton, Califomta 95205 <br />BuBineu: (209)468-3420 <br />>** • ■•sfi*1' ■ <br />7. Electricity is provided for my booth’s use: <br />8. ] <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />ill food.vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />Date(s): <br />becklist to the ftetival coordinator three (3) weeks prior to this event. <br />.. Name of Event: <br />L The following is information about my organiz^cm/business. <br />Name of orgamzation/business: <br />Address: <br />Phone: 7^? - ■ - Alternate: <br />3. List food to be sold or given to foe public: <br />4. lam providing food font is NOT prepared at home: b(J Yes [ ] hlo <br />AU food u prepared on-site or is from approved commefcialfecilities; MYes [ ]No <br />Name of facility: Phone: <br />Address of facility: /9,'7l7^' <2^2—------------- <br />5. i am providing a booth with foe following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and foe public) <br />bj A booth with walls and ceiling constmcied of either wood, canvas, plastic, similar material and fine <br />me^b. fly screening, completely enclosing open food areas. It will also have a smooth and cleanabie floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ J Other (specify}:_____ ____________________________________—— ------------— <br />Notes 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 />5. Approved water for drinking, utensil and hand washing will be provided in my booth by ths following <br />- methods: <br />M Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />[ ] Other (specify): <br />' - ‘ : fflYes []Nb <br />I am proving en accurate probe thermometer to measure ths hot and cold holding of potentially hazardous <br />foods during all time of booth operation: [/KYes [ J No <br />I am providing foe following hM temperature controrfor foe-hot holding of all potafoafly hazaidous foods <br />above 135 degrees Fahrenheit: <br />Camp Stove [ ^Double steamer [ ] Electric stove top <br />[ ] Sterno & hotel trays [ ] Steam table & lids [ ] Other (specify):-------------------------------- <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products.