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Environmental Health Department TEMPORARY FOOD VENDOR’S APPLICATION 1. 2. J Address: ) 3. 4. 5. Other (specify): those which sell beverages from 6. On-site hose bib that is connected to a potable water source. 9. meats, tamales, cooked beans, rice, I I ■I N A 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I EHD 16-02 Page 7 of 11 1 07/3/17 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. 7. 8. Other (specify):_ __ _______ Electricity is provided for my booth’s use: Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous I am | 135°F: Camp stove Double steamer Electric stove top www.sjcehd.com TEMP EVENT APP j I i SAN JOAQUIN ------COUNTY- The following is information about my organization/business: /Th vV ?(>ao 4- ya Note: The only operations not required to provide enclosed booths are approved dispensers, or prepackaged foods from approved sources. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. foods during all times of booth operation: Yes No providing the following hot temperature control for the hot holding of all potentially hazardous foods above Sterno & hotel trays Steam table & lids Other (specify) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to ; event. Date(s): 36C >' VTA. / S Name of organization/business: ^71 JaJ '■ Alternate: ( I Is < C. I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: I I Yes | | No Name of facility:Phone: ( ) Address of facility:___ ________________________________________________________ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 7911 ur Of I______ L ■ Ct TSTT > Phone: p O' j) 4" 371? ^ List food to be sold or given to the public: the festival coordinator three (3) weeks prior to this 1 .Name of Event: are.;•.X