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7124/23'2:37 PM 20230724_142221.jpg <br /> S A N J O A Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All loud vendors(bolts for profit and non-profit)are rrquired fo return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to th,.s event- _ <br /> t 1.Name of Event: <br /> ?n� � Gti 7 1 /t Date(s): �1 t �`, <br /> 2 The following N snformation about my organization/business <br /> Name of organization/busmess:_�L 1 L v_ \ Gti' <br /> Address <br /> Phone: {yU� ) C�lL ` —7 77-Cl Alternate: ( er] <br /> 3. lust Rood to be sold or given to the public- t Vj C' 8 0 <br /> 4. 1 am providing food that is NOT prepared at home: ] Yes❑No <br /> All food ss prepared on-site or is from approved commercial facilities=❑Yes❑No <br /> Name o ity: Phone.l ) <br /> Address of facility <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged too <br /> d 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 tme mesh fty <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) - L:(j tf,tt�l- <br /> Note: The only opera1113ns 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 tar 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): '0 � t I f <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(speoly) <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 l F 209 464-0138 4 www.sjgov.orglehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06 W19 <br /> https llmail.google-com/mail/u/0/#inbox?projector=l 1/1 <br />