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S A N ! O A Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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. 1.Name of Event: l3 �, Date(s): <br /> 2. The following is information about my/organization/business: <br /> Name of organization/business: <br /> Address: C <br /> Phone: Aftemate: ) �� <br /> 3. List food to be sold or given to the public: -� � <br /> 4. 1 am providing food that is NOT prepared at home: Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: EfYes❑ No <br /> Name of facility: Phone: (2-1 tj <br /> Address of facility: —Sia,4,4 CT- ry 'z G <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> Ea'A booth with walls and ceiling constructed of either wood, canvass, plastic, similar material and fine mesh fly <br /> 4; 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_ <br /> ❑ Other(specify): <br /> Note: 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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> [Approved bottled water. <br /> 9On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes❑ No <br /> 8. 1 am providing an accurate probe thermortletgr to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: LTYes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135*F: <br /> camp stove Erstemo&hotel trays <br /> ❑ Double steamer ❑Steam table& lids <br /> ❑ Electric stove top 210ther(specify) 6-tt-�t4( <br /> Note: Examples of potentially hazardous food include: meats, tarnales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue j Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 o111 TEMP EVENT APP <br /> 05/19/19 <br />