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SQNJOAQUIN 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 to this event, <br /> 1. 1.Name of Even C ®ems dS l�cJ H L 6 ,�► O/,J S �, e �� �10 e� <br /> l�H S <br /> 2. The following is Information about <br /> --my--'�--organization/business: <br /> Name of organization/business: C_a CoId-3 _ <br /> Address: 73 G 4 6 <br /> Phone: �Uq ) �05--�,5�2,� //Alternate: <br /> 3. List food to be sold or given to the public:J�urr� fr1S % cSLfaE'r 11 N Z_ <br /> 4. I am providing food that is NQQJ prepared at home: Q'�es❑ No <br /> All food is prepared on-site or is from approved commercial facilities:O'Yes❑No <br /> Name of facility: Ca lerf VLA Phone:We* 50 5—6 5.2.0 <br /> Address of facility: 7 Te dr s 1 �i1�,c E/9 9%3G7 <br /> 5. I am providing a booth with the following. (to protect my unpackaged food and food-preparation areas from files, <br /> dust and the public) <br /> �A booth with walls and celiing 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): <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 /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: es 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: 2Yes❑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 /> lKamp stove ❑Sterno&hotel trays <br /> double steamer ❑Steam table&[Ids <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 /> 1EHD 868 E. Hazelton Avenue I Stockton, California 95205 i T 209 468-3420 i F 209 464-0138 i www.sjcehd.com <br /> 07/3/17 02 Page 7 of 11 <br /> TEMP EVENT APP <br />