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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2, <br />Address: <br />91 £-216-6238 (’hone:1. <br />3. <br />4. <br />5. <br />6. <br />9. <br />XI Approved bottled water. <br />[_XOn-site hose bit) that is connected to a potable water source. <br />7. <br />8. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of (his checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />[ | Storno & hotel trays <br />| ] Steam table & lids <br />fX other (specify) heat lamps <br />1. Name of Event: JLOD! GRAPE FESIIVAL Date(s)f I'H / 2^2^ <br />The following is Information about my organization/buslness: Name of organlzation/busincss: <br />Capitol Concessions _ _ <br />SAN JOAQUIN <br />: • ) .X! ■ V <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />18(58 1 I lazolton Avenue | Stockton. Cahlorma 952()'» | I 209 '1(58 3470 | l: 209 46'1-0138 | www.sjgov.oig/ehd <br />mo 16.02 1'000 7 0(11 TIMPI VI NI API' <br />06/19/19 <br />I am providing food that is NOT prepared at home: (XI Yes [J No <br />All food is prepared on-site or is from approved commercial facilities: [X Yes | J No <br />Name of facility:Phone: (------)--------------------------------- <br />Address of facility:------------------------------------------------------------------------------------------------------------- -— <br />I am providing a booth with the following: (to protect my unpackagod food and food-preparation areas from flies, <br />dust and the public) <br /> A booth with walls and ceiling constructed of cither wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cloanablo floor (concrete, <br />asphalt, cican tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />HOther (specify): .Food Traile,: „_____________________________________________________ <br />Noto: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods: <br />meats, tamales, cooked beans, rice, <br />LI Other (specify):________________. <br />Electricity is provided for my booth's use: ( XYcs [J 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: [)(] Yes L) No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF: <br />[ J Camp stove <br />I 1 Double steamer <br />[ ] Electric stove top <br />List food to be sold or given to the public;Alternate: ( )-------------------------------------- <br />Corn Dogs Cheese on a Stick sodas Lemonade water