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S A N J DA Q U I N Environmental Health Department <br /> ----COUNTY-- <br /> ,a„rop', Greatness 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 three(3)weeks prior Ato(this event, ` ' <br /> 1. 1.Name of Event: E Vv F—C S Date(s): I C — <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organization/business: <br /> Address: 1� r � ��C <br /> Phone: (OUL Alternate:( } <br /> 3. List food to be sold or given to the public: T6�(C)S W yr,VaS, _(iQU1 w1 ­y1WN ) <br /> 4. 1 am providing food that is NOT prepared at home: ❑Yes ( No <br /> All food is prepared n-site or is from approved commercial facilities: Yes❑ No <br /> 1�Y I 1 Ul TC t U. _ (Gi�� phone: (�Name of facility: Q L <br /> Address of facility: V\QVV(k� �''� L-L7 v �' On C!�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 /> Xther(specify): ��T} (� 1 \j \ - <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 /> 0on-slite hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use:NYes❑ No <br /> 8. 1 am providing an accurate probe thermoTe er 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&ntrol for the hot holding of all potentially hazardous foods above <br /> Iq35°F: <br /> Camp stove ❑ Stemo&hotel trays <br /> ,XDoubte 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 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHa 16-02 Page 7 of 11 TEMP EVENT APP <br /> o6I19119 <br />