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SAN JOAOUIN L." n v i ro nine n ta I 11 ea I it i De pa i tin ent <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i <br />2 <br />Address: <br />Phone: <br />3. <br />4 <br />5 <br />G <br />9 <br />209 4610133 | sjqov oig'rlul <br />it vf’i vrnr ai:i> <br />L I Other (specify): ... ------------------------------------------------ <br />Noto: 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />7 <br />8 <br />I3(i>: | I h.i/eltuii Avonue I Stockton California 95205 | T 209 4(i8 3420 | I <br />I HI) IG O? Page / o’V <br />06’19/19 <br />meats, tamales, cooked beans, rice, <br />. Date(s): M <br />[ ] Slerno & hotel trays <br />O Steam table & lids <br />yj Other (specify) <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 Name of Event <br />( | Approved bottled water <br />^^On-site hose bib that is connected Io a potable waler source. <br />[ J Other (specify).------- ----------------------------------------------------------------------------- <br />Electricity is provided for my booth's use/Lx! Yes [ I No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: [ I Yes ( I No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <br />| J Camp stove <br />| ] Double steamer <br />I | Electric stove top <br />The following is information about myyganiz.atiorybiJsiness^// <br />Name of organization/business:.. <br />'T&v iL <br /> Alternate ( <br />l.ist food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: (ZJ Yes ( I No <br />All food is prepared on-site or is fronypproved commercial facilities: | | Yes [ I No <br />Name of facility ^onc:()........ <br />Address of facility:_______— - <br />I am providing a booth with the following: (Io protect my unpackagcd food and food-preparation areas from flies, <br />dust and the public) <br />y \A booth with walls and ceiling constructed of cither 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.