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°� , SA6JOAOUIN Environmental Health Department <br /> COUNTY <br /> \9c,��R P Greatness grows here. <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. <br /> 1. 1.Name of Event: ?JE ! ({(ak t2 j'1 ` (, Date(s): 23 <br /> 2. The following is information about/m�y organ ization/business: <br /> Name of organ ization/buusiness: _G/ SQ 'Z'yo,�,V KI+C(7c,� <br /> Address: ( ck i f ornic` S+ IGfzi ,4 g52,0 G <br /> Phone: (2 o ¢S 6-q 0 0 Alternate: (20 6 Z 9 --7 c5 Z <br /> 3. List food to be sold or given to the public:.A I f'ic tin F-0og C k Niri!!:5L od <br /> 4. 1 am providing food that is NOT prepared at home:)?fYes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities:VYes ❑ No <br /> Name of facility: 6a\i-�Ulr V& (,Q-}�r i yj (d M Uh i 5(�i,r c� Phone: (20 G) 4-6 4- - q-70 <br /> Address of facility: 730 Ca I,4or r,i a. St, S+c)ck+Qn . (-A QSZ.o 6 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> VA <br /> and the public) <br /> L�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 /> Approved 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:M Yes ❑ No <br /> 8. 1 am providing an accurate probe thermomeLor to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:9 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(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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06/29/2023 <br />