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i <br /> „i <br /> a <br /> i <br /> i <br /> S A N D DA Q U(N Environmental Health Department <br /> C 01.I1v1 I y <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 checkiiat to <br /> the festival coordinator three aweeks prior to this event. . "? <br /> JJ i <br /> 1. 1.NameofEvent; L � ��GfC Frer _ Z �1 � <br /> 2. The following is infomnation about my organizati <br /> on <br /> /business- <br /> 1 <br /> Name of organization/business;'-�L '7 I P S 4L b - - '-t�� <br /> Address: z-j�Y� /t''A rcv/ r�✓� ��G '7 0 <br /> Phone. (��) O�J'�aFJ�/ Alternate:( ) <br /> 3. List food to be sold or given to the public virr /'g_$ 'ce5. ayr-q 4 <br /> 4. 1 am providing food that is NOT prepared at home:UKe's U No ✓a""�� <br /> All food is prepared on-site or Is from approved commercial facilities: es El No <br /> Name of facility: f � r 9 ne: , -"5(-? <br /> Address of facility: u Z >r e ✓�r��ti <br /> 5. 1 am providing a booth with the folio ing:(to protect my unpackaged food and food-preparation areas frorn flies, <br /> dust and the public) <br /> Cj�'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. <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 /> (proved 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: es❑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: es D No <br /> 9. 11 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 13 <br /> F: <br /> amp stove ❑Sterno&hotel trays <br /> ouble 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 Stockton,California 95205 j T 209 468-3420 1 IF 209 464-0138 j www.sjcelld.com <br /> EI10 16-02 Pawn 7 of 11 I IiMF'EVENT APP <br /> 0713/17 <br />