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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />__Oate(s).1 Name of Event:I odi Grape festival 1. <br />2. <br />Addresa: <br />) Alternate: (Phono: <br />3. <br />4, <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />1EMP EVENI APPPhuo ’ ol 11 <br />7. <br />8. <br />□ Other (specify):—— ----------------------------------------------------------------------- <br />Noto: The only operations not required Io 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 be provided in my booth by the following methods <br />O Approved bottled water, <br />Q-On-sIle hose bib that is connected to a potable waler source. <br />All food vendors (both tor pro’it and non-profit) are required to return a signed and completed copy of this (.hucklist <br />Io the festival coordinator throe (di weeks prior to tills event. <br />1868 E, Hazelton Avenue I Stockion. California 95205 | T 209468-3420 | F 209 464-0138 | www .sjgov.org/ehd <br />EHOI602 Phu. roll I IEMPEVEN1AI <br />06H onn <br />Dr L/<- <br />I am providing food that is NOT prepared a! homo: U Yos No <br />All food is prepared on-site or is from approved commercial facilities: CT Yes [.] No <br /> Name of facility: Phone: (-----J---------------------------------- <br />Address of facility: ~ /1? <>v/ M___J2’ ----------------------------------------i-------------------------—— <br />I am providing a booth with the following, (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />Q-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 « 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 />Electricity is provided for my booth s use: LJ Yes LJ No <br />I nm providing an accurate probo thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: [J Yos No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />136*F: <br /> Camp stove Sterno & hotel trays <br />[ ] Double steamer (3 Steam tnhlo & lids <br />[3 Electric stove top C.1 Ottier (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />Hie foliovying is information about my organization/buslness: <br />Name of organizatlun/businoss. ' <br />/ o y n <br />( TC 7______ <br />List fond to be sold or given to the public: