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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.I.Nunio of Hvonl: <br />2. <br />3. <br />4. <br />5. <br />6. <br />| | On-slto hoso bib that is conn Oded to h potable walor sourco. <br />9. <br />moats, tainalos, cooked boons, rice, <br />7. <br />0. <br />Approved walor for drinking, ulonsil and hand washing will bo provided in my booth by tho following methods: <br />l -I Approvod bottled walor. <br />Noto: The only operations not roqulrod to provide enclosed booths arc those which sell bovoragos from <br />approved dispensers, or prepackaged foods from approved sources. <br />O A booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. Il will also have a smooth and cloanablo 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 />I | Other (specify): AS , <br />SAN JOAQUIN <br />COUN I Y <br />l^ilo(s): <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />r 1 Storno & hotel trays <br /> Steam table & lids <br />I’J Other (specify) <br />IBWII-. Iln/ollon Avenue | Stockton, California 95205 | I 209 468 3420 | I 209 464 0138 | www.Sjgov.oig/oh<I <br />r.lll) 1G0Z I'non /iiltl inMI’I-WNI Af’l’ <br />or./1 !)/i I) <br />O Other (specify):____________________________ ______________________________ __________ <br />r.loctricily Is provided for my booth's use: FfTYos No <br />I am providing an accurate probe thormomotor to measure tho hot and cold holding of potentially hazardous <br />foods during all limos of booth operolionU^Yos O No <br />I am providing tho following hot tomporaturo control for tho hot holding of all polontially hazardous foods above <br />135T: <br />[ | Camp stovo <br />J Double steamer <br />| | l-loctric stove lop <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of Illis checklist to <br />tho festival coordinator throe (3) wooks prior to (bls event. <br />k!iI,V.<L ( < I. i V\! 11 ....... <br />I ho following Is information about my organlzation/businoss: <br />Name of organlzallon/buslnoss: <br />Address: <br />I ’hone:Alternate: <br />l ist food to t)o sold or given to tho public: 1^7777 .777777^? <br />77/7^. <br />I am providing food that is NOT prepared al homo: CTYos |..) No <br />All food Is prepared on-slto or Is from approved coinmorcial facilities: ETYos FI No <br />Nn.no of My: ^Z-/ <br />Address of facility:.^? // C-STy » T’S __ <br />I am providing a booth wilh tho following: (to protect my unpackagcd food and food-proparation areas from flics, <br />dust and tho public)