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SAN.lOW N Environmental Health Department <br /> —COUNTY— <br /> Greotness grows here. <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 th�(3)weeks prior to this event. <br /> og�G1. 1.Name of Event: Q "jle� Date(s): 8 <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: CAACIJ M W <br /> Address: I I O D M`(,h,*rw 8I 1/ <br /> Phone: ( ql(/) 3jo-3gn Alternate:(q<</ )y 9 14LL- <br /> �` Clwc - 39 94 z z. <br /> 3. List food to be sold or given to the public: T .� <br /> 4. 1 am providing food that is NOT prepared at home:[gKes❑ No <br /> All food is prepared/on-site or jp from approved commercial facilities:211yes❑No <br /> Name of facility: 1 Imo—•/� (� Phone:( ) <br /> Address of facility: `L�j <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 /> ❑ 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): �00,(-1 44cf*— <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 toa potable water source. <br /> Kle <br /> r(specify):—�Jl►' A V'' � �►�� <br /> 7. y is provided for my booth's use: ❑Yes❑ No i hazardous <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially <br /> foods during all times of booth operation: ❑Yes ❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑ Sterno&hotel trays <br /> ❑ Double steamer steam table&lids <br /> ❑ 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 /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.sjgov.orglehd NT <br /> TEMP EVENT APP <br /> EHD 16-02 Page 7 of 11 <br /> 06/29/2023 <br />