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SAN .JOAQUIN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPUCAT01��,q, <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 Event:T-A­TAI-e-IC-A �-1 V-:5 O'S Date(s). <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: 1-oc) <br /> Address: b oq-t 1,q yve— <br /> Phone: q A�o i <br /> ............ 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;.,�-Vyes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: El Yes ❑ No <br /> Name of facility: Phone: <br /> Address of <br /> 5. 1 am providing a booth with the following: (to protect my u—npacka—ge—d food-and <br /> dust and the public) food-preparation areas from flies, <br /> SLr' -A"I'moth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine rvesh fly <br /> deening, 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 farad prepanation <br /> areas from the public. <br /> F-I 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 /> El Other(specify): <br /> -7, Electricity is provided for my booth's use: Ye s2 <br /> No <br /> I am providing an accurate probe thermometer�.,�'neasure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: I,-]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 /> 1-1 Camp stove 0 Sterno&hotel trays <br /> Double steamer M Steam table& lids <br /> Electric stove top 0 Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, Potato salad, eggs,and dairy products. <br /> 1--l4a4relton Awj <br /> 'I Stocktonjyuv.c�rca/i lid <br /> , Californ4-,i 9520,5 1 T 209 4,68-3420 J F 2U1;)46d.-Q1�'W I www�,,j <br /> Pnge 7 of 11 <br /> TEMP EVENT APP <br />