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TEMPORARY FOOD VENDOR’S APPLICATION <br />July 21,20161.1. Name of Event: Date(s). <br />2.The following is information about my organization/business. <br />A1 AG Farmers MarketName of organization/business. <br />10910 S. Manthey Rd, Lathrop CA 95330Address: <br />345-2155(209 )Alternate: ( Phone: <br />local produce3List food to be sold or given to the public: <br />4. <br />5. <br />Inside at kitchenQ Other (specify)' <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods.6. <br /> Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />S Other (specify):Facility kitchen on site <br />Electricity is provided for my booth’s use. Q Yes No7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />7/14/15 <br /> Camp stove <br /> Double steamer <br />[x] Electric stove top <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 />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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <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 />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 />Farm to Fork <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <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: 0 Yes No <br />I am providing food that is NOT prepared at home1 5(] Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: H Yes No <br />Name of facility: San Joaquin County Fairgrounds Phone: ( 20^ 466-5041 <br />Address of facility. 1658 S. Airport Way Stockton, CA 95206 _