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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s) <br />2. <br />( <br />Address: <br />3. <br />4 <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />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 />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 />SAN I0A0UIN <br />COUNTV <br />Note: Examples of potentially hazardoua food Include: <br />vegetables, potato aalad, egga, and dairy products. <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. <br />|vV'5>___________ <br />y J <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.siqov.org/ehd <br />EH01W2 Pap 7Of 11 TEMP EVENT APP <br />0W1S/1S <br /> Other (specify): _________> <br />Electricity is provided for my booth's use:© Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during 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 />1 .Name of Event. SCO \ QU k <br />The following is information about my organizabon/business: <br />Name of organization/business: 1 <br />Phone: ) 53*4-71^ Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:^ Yes No <br />All food is prepared gn-site or is from approved commercial facilities'^) Yes No <br />Name of facility. SfpdrT TA Phone: ( S'-^^5 I <br />Address of facility: ^0(5^ STt? | <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />I <br />Q 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 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 />I k a