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SANJOAHIN Environmental Health Department: <br /> C0UI,," <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. i <br /> 1. 1.Name of Event: NW�1� � 1�r"y � ��(1 -�G')� �i t' Date(s):-)!-W,�- 1/ a oezq <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: <br /> Address: clk- �l <br /> Phone: ( �;"1) /-'> /�i Alternate:( ) <br /> Y- 1 <br /> 3. List food to be sold or given to the public: or,\ y1 <br /> 1 <br /> 4. 1 am providing food that is NOT prepared at home: (Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities:Yes❑No <br /> Name of facility: Phone: <br /> Phone:f ) <br /> Address of facility: — <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 /> 9cr ening, 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 /> i <br /> ( Approved bottled water. <br /> I ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): , <br /> 1. Electricity is provided for my booth's use:ID Yes❑ No <br /> 8. I am providing an accurate probe thermo�etel,r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operatio es❑No <br /> 9. 1 am providing the following hot temperatuontrol for the hot holding of all potentially hazardous foods above <br /> 35°F: <br /> Camp stove ❑Stemo&hotel trays <br /> Double steamer ❑Steam table&lids f� <br /> ❑ Electric stove top Other(specify) r <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br />