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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-^71.1 Name of Event <br />2. <br />Address <br />Phone ) <br />3 <br />4 <br />5 <br /> Other (speedy)' <br />6. <br /> On-srte hose bib that ts connected to a potable water source. <br />9 <br />meats, tamales, cooked beans, rice. <br />Approved water for dnnkmg. utensil and hand washeig will be provided in my booth by the following methods <br />Approved bottled water <br />fh A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal and fine mesh fly <br />screening, completely enclosing open food areas. It wiS also have a smooth and cieanabie Poor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Nets: The only operations not required to provide endosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />7. <br />8 <br />135*F: <br /> Camp stove <br /> Double steamer <br /> Electnc stove top <br />SAN JOAQUIN <br />COU\’ '• <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods dumg all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 I www siqov oro/ehd <br />EMO 1*02 P^«7 0l 11 It*** EVENT APP <br />(Mfiwit <br /> Other (specify)- <br />Electnoty is provided for my booth s use:5© Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Dpi __________ __ _______ <br />fAQ/J____Lf / A ^7. Cl I______ <br />~7 iQ f3 Alternate ( ) <br />Lst food to be sold or given to the pubic littJcT, <br />I am providing food that is NOT prepared at homeZ© Yes Q No <br />All food is prepare^gn-site or is from approved commercial facilities'^ Yes O No <br />Name of facility .^(YYirl fUYT Fl AfVl Phone- ( 7 ^2 S - J7 <br />Address of fadlrty | FA. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparabon areas 'torn flies. <br />dust and the public) <br />AN food vendors (both for profit and non-profit) are required to return a signed and cot pie tod copy th s crec<i ■/ t'j <br />the festival coordmator three (3) weeks poor to this event <br />F \ r.o Park T?-k-. <br />The following is information about my organtzabonjbusmess <br />Name of organizabon/business nr T)(>1 U <br />^0