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Ir ''� ��� SANS Q <br /> '' �;: �OA UIN Environmental Health Department <br /> +=' COUNTY <br /> �,_,.Y rof test q ows dire <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-Profit)are required to fetum a signed and completed cry of this cfleckGst to <br /> the f,estiv;al coordinator three(3)weeks prior to this even!_ <br /> 1. t.Nerre of Event- s (,` �` n C4 Dates) (v-/7--ZC/L7- <br /> 2. The following is information about my orgaNzatiorllbuskrWW <br /> Name of organizatk ngminess: �o <br /> Address: 17 v e <br /> Phone: t(,937 Ornate: <br /> , <br /> 3. List food to be sold or given to the public: 1 v l[ed f 4— �,,,du, <br /> 4. 1 am providng food that is NOT prepared at home:k Yea❑No <br /> All food is prepared.° 1 or is from approved commercial f okt%s:5LYes❑No <br /> Flame of%wqy: TAT C" & Ph. � Z_3 44 <br /> Address of Wfity. r 7 N9 ,` c q <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 /> ,K,A booth with walls and ceiling constructed of either wood, canvas,plastic aimiiar material and foe meshy <br /> screening, oompledsly enclosing open food areas. It will also have a smooth and deanabke floor (concrete, <br /> asphalt clean tarps and smooth wood are acceptable)and constructed to separate food and taod prepambon <br /> areas from the public, <br /> ❑other(specify): <br /> Note: The only operations not required to provide enclosed booft are those which "I beverages from <br /> approved dispensers.or prepackaged foods from approved sources. <br /> S. Approved water for drinking,ulensiI and hand washing wilt be provided in my booth by the!following rrle6hods <br /> Approved bottled water. <br /> ❑Or"Ite hose bib that Is connected to a potable water source. <br /> ❑09W(specify): <br /> 7. Electricity Is provided for my booth's use Yes <br /> 8. 1 am providing an accurate probe theffnCIMMOr to"asure ft hot and cold holding of potentially hazardous <br /> foods dunng all times of booth operation,SUes No <br /> 9. I am providing the following hot temperature control for the hot holding of all potentialty hazardous foods above <br /> 135'F <br /> ❑camp stove Stemo&hotel trays <br /> ❑Double steamer ❑Steam table b ffds <br /> ❑Electrrc stove top ❑other(specify) <br /> Note: Examples of potendally hazardous food tncluds: meals, tamale*, cooked beans, rke, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E Hazelton Avenue I Stockton,California 952051 T 209468-34201 F 209 46"138 1 www sjgov.org/ehd <br /> rho 1642 P"roc 11 <br /> 06(l ools TEMP EVENT A" <br />