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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): I.Name of Event: 1. <br />The following is information about my organization/business:2. <br />1Address: <br />(Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />6. <br />9. <br />include:meats, tamales,cooked beans, ric< <br />7. <br />8. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist1 <br />the festival coordinator three (3) weeks prior to this event <br />Name of organization/business: <br />4'Z 4 <_ <br />‘T "7-- Alternate: ( ) <br />I am providing food that is NOT prepared at home: Yes <br />All food is prepared on-site or is from approved commercial facilities: ¥65,0 No <br />Name of facility:Phone: ( ) <br />Address of facility:______________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flie <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh f <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concreti <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparatic <br />areas from the public. <br /> Other (specify): <br />HaZelt°n A''enue| Stockton, California 95205 | T 209 468-3420 | F 209 464 01 nn , <br />Page/om 1 404-0138 | www sjgov.org/ehc <br /> TEMP EVENT/ <br /> <br />Note: The only operations not required to provide enclosed booths are those which sell beverages fror <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 /> Approved bottled water. <br />j3bn-site hose bib that is connected to a potable water source. <br /> Other (specify): <br /> Electricity is provided for my booth's use: E^es No ' <br />' ,he hOt and COld h0,din9 of P°ten'ia"y ^ardou <br />I am proving the foltowing hot temperature control for the hot holding of all potentially hazardous foods abov <br /> Camp stove ^B^temo & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food <br />vegetables, potato salad, eggs, and dairy products?