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° <br /> ~ <br /> ` � � AJ �� � U / �� <br /> ��� [H }��� U U H (� E�v`�o n niqi,na rn^ ^ �H'j r a- h �e p a rc m^e nti <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-pmfit) are required ho return a signed and completo u�yof�iooh��i�� <br /> �e�n�a|mm�in���me(�we�o��hn��o�n - <br /> 1 1 Name ofEvent: Date(e): <br /> Z The following is information about my organ ization/buameea: <br /> Name of organ izadon/buoineoo: <br /> Address: <br /> Pho <br /> ne: (2�0-l) Alternate.- <br /> 0 List food tobe sold m given to the public: <br /> 4. |am providing food that is NOT prepared sd Yes F� No <br /> All hood is prepared on-site oria from approved commercial facilities.- 0 Yes Fl No <br /> Name offacility: Phone: <br /> Address ofhaoi|hy� <br /> 5. | am providing a booth with the following: (to protect my <br /> � <br /> - <br /> ed food and g��and �m�utdk� food-preparation ��s fro'—� ' <br /> -- <br /> � � <br /> L�,� booth with walls and ceiling constructed of either wood, nonvao, p|eaUc, similar material and fine mesh fly <br /> ocreening, completely enclosing open fond areas. |t will also have momooth and cleanable floor (ounor*te <br /> asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> ` <br /> areas from the public. <br /> Ej Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which msU beverages from <br /> approved diopenaera, or prepackaged foods from approved sources. <br /> 8 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> � � <br /> J���pprovedbott|edwater- <br /> On-uihehooebibthati000nnectedtoopotablewmb*roounoa. <br /> Other(specify): <br /> /. Electricity io provided for my booth's use:' <br /> 8. | am providing an accurate pnzbathomn-- --meeounn #he hot and cold holding of potentially hazardous <br /> foods during all times ofbooth operation: El Yes Fl No <br /> drQ� | em providing the foUmwinghot temperature control <br /> --for the hot holding ofaUpn&andaUy hazardous foods above <br /> ~( — 135~F: <br /> LJ Camp stove El Stemno& hotel trays <br /> 0 Double steamer El Steam table&lids <br /> [-1 Electric stove top E] Other(specify) <br /> Note: Examples of potentially hazardous VomW include: meats, tamales, ommkmd beans, rice, <br /> vwgetablmw, potato salad,eggs,and dairy products. <br /> 1868 E. Huze|VnnAvenue / Stockton. Ca/i(ornimQ52O5 j T 280468'3420 1 F 209464-0130 1 w"�w.sjgovnrg/ehd <br /> 06/2912023 Page rm1/ TEMP EVENT app <br />