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SA N J OA Q U I N Environmental Health Department <br /> COUN'v <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. f f <br /> 1. 1.Name of Event: _(�)'� t Mc°(�►'� S f fC�►" ra Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: �c S ° A_- Y <br /> Address: rr/ •� G r� �-T <br /> Phone: �0 Sn j—6 cj Alternate:( ) <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:ff]Yes❑No <br /> All food is prepared on-site r is from approved comme�ial facilities:❑Yes❑No <br /> Name of facility: n 14A1 Sc+r.� /�ppt p5fe Phone:( ) <br /> Address of facility:/?// 5 -71X y/- Me, S I-O <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged 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. D 'j� <br /> ❑Other(specify): %6_0 i y__C,r /6 V_ <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 /> 41,4proved 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:❑Yes❑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❑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 ❑Sterno&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 1 Stockton.California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 <br /> 06119M9 TEMP EVENT APP <br />