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SANJOAQUIN Environmental Health Department <br /> .! --COUNTY - <br /> � Greatness grows hrre. <br /> �L IFS <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 /> ,q the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Evenl. date(s): Z — <br /> 2. The following is Information about my organization/business- <br /> Name of orgaNzabonlbusiness: ODt"� } <br /> Address: '—po <br /> Phone: ) 5Ct£Q T I d— Altemate: <br /> [� CL� <br /> 3. List food to be sold or given to the public:, l � <br /> 4. 1 am providing food that is NOT prepared at home.QL`Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes❑No <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, <br /> F dust and the public) <br /> dry 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 a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceplable)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 /> ET-Approved bottled water. <br /> ❑On-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 thermometer to measure th hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:E]Yes❑No PV <br /> 9. 1 am providing the following hot temperature control for the hol holding of all poterUaliy hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove lop ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meals, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orgfohd <br /> EHD 1"2 Page 7 of I TEMP EVENT APP <br /> 06119Jf 9 <br />