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TEMPORARY FOOD VENDOR’S APPLICATION <br /> <br />Note: <br />[ ]No <br />J <br />” %8 East Hazelton Avenue, Stockton ^Mifornia 95205 <br />BlBl.es,: (209)468-34^ <br />1. Name of Event: <br />2. The following is information about my organization/business: <br />Name of organization/business: <br />Address: <br />Phone: 7^7Phone: ^LbJ 7 '^-7 Alternate: 7^ 7 <br />3. List food to be sold or given to the public: <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />checklist to the festival coordinator three (3) weeks prior to this event. <br />Date(s): <br />4. I am providing food that is NOT prepared at home: [7] Yes [ ] No <br />All food is prepared on-site or is from approved commercial facilities: [ d Yes [ ] No <br />Name of facility: Phone: '^7 <br />Address of facility: Z7 77 <br />5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />M A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ ] Other (specify):____________ _______ ____________ <br />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 <br />methods: <br />M Approved bottled water. <br />[x; 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: <br />8. I am providing an accurate probe thermometer to Measure the hot and cold holding of potentially hazardous <br />foods during all time of booth operation: [/^Yes [ ]No <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />above 135 degrees Fahrenheit: <br />[z^ Camp Stove [^Double steamer [ ] Electric stove top <br />[ ] Stemo & hotel trays [ ] Steam table & lids [ ] Other (specify): <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />K] Yes <br />a m< <br />[^Yes <br />trol ‘