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p•°r;C. <br /> SALMON N Environmental Health Department <br /> C O U f•a 1-y <br /> �i���� Greotnets greys Kerr <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)reeks f prior t this r�event <br /> 1. 1.Name of Event- I 1 l �[A_ Date(s): 0 2-2 <br /> 2. The fallowing is information about my organizatiorvb in-ess: <br /> Name of organizatiorvbusiness: '9[ <br /> Address •2`"C_ A - <br /> Phone: {20°() 2_1 `) � —63 "Lb Alternate:at)D • --L 1 <br /> 3. List food to be sold or given to the public: LQ Q A <br /> 4. 1 am providing food that is NQTT prepared at home:4 yes❑No <br /> AN food is prepared Gn-si tA or is from pprov commercial fediti�s: }-Yea❑No <br /> Name of facility: �� Phone: <br /> Address of facility: N^�� S2 <br /> 5. 1 am providing a booth with trio following: (to protect my unpacksged food and food-preparation areas from flies, <br /> dust and the public) <br /> 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 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 /> ❑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 therniorn <br /> ter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation Tres❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1 35°F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> 0 Double steamer ❑Steam table 8 lids <br /> 0 Electric Stove top ❑Other(specify) <br /> Note: Examples of potentially hazardoue food Include: meats, females, cooked beans, rice, <br /> vegetables,potato salad,eggs, and dairy ptroducta. <br /> 1868 E Hazeltcn Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sjgov org/ehd <br /> EHO 16-02 Pop 7 d 11 TF MP EV E Nr APP <br /> odlwip <br />