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S A N J OAQ U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a signed and compieted copy of this checklist to <br /> the festival coordinator three (3)weeks prior to this event <br /> Name of Event _-�,��� i✓ 1T "���(_�TC4 <br /> Date(s): c Z i_ 1_(( <br /> 2. The following is information about my organ izationlbusiness <br /> Name of organization/business- <br /> Address: <br /> Phone. ' �� Alternate- <br /> 3 list food to be sold or given to the ublic' <br /> 4. 1 am providing food that s NOT prepared at home. [_dyes L] No <br /> All food is prepared on-site or is rom approve, <br /> commercial aGl ties P P rl/Yes L] No O'n <br /> Name of facility. Phone ( ) <br /> Address of facility <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 /> LV 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 ciearabie floor (corcrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate focc and food preparation <br /> areas from the public. <br /> C' 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 aporoved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my boom by the°oilowing methods <br /> [V 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 therrnome r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation [ Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the not holding of all potertially hazardous foods acove <br /> 135°F <br /> ❑ Camp stove ❑ Stemo 8 hotel trays <br /> ❑ Double steamer [Steam table Y lids <br /> E ❑ Electric stove top ❑ Other (specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice. <br /> vegetables, potato salad, eggs, and dairy products. <br /> 1868E Hazeltor Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-CI'38 1 WWvv 5jgC;v.TEMP EVENT APf <br /> t)Ef ?8-02 Page 7 0l tt <br /> oBdta'!9 <br />