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Environmental Health Department <br /> SAN�lOAQUIN <br /> —COUNTY— <br /> 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 r�r )weeks prior to this event —7) � Zo 18 <br /> 1. 1.Name of Event: <br /> Date(s):� <br /> 2. The following is information about m1 ���-�-� �y Y/organization/business: <br /> C �'r i <br /> Name of organlzation/business: � <br /> � l <br /> Address: l <br /> � � "�:J Y1 n` o <br /> Phone: 1 .`1I:c Alternate: ) ( > j <br /> (� <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that Is NOT prepared at home:A]71'es❑No <br /> All food is prepared on-slte or is from approved commercial facilitles:�+'es[]No <br /> Phone: <br /> Name of facility: <br /> Address of facility: <br /> 5. I am providing a booth with the following:(to protect my unpadcaged food and food-preparation areas from files, <br /> dust and the public) <br /> sh fly <br /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and flne�n refs <br /> screening, completely enclosing open food areas. It will also have a smooth cleanable <br /> preparation <br /> asphalt, clean tarps and smooth wood are acceptable)and constructed to separate <br /> areas from the public. <br /> 10 Other(specify): <br /> or .required to repackag foods from From approved sources. those which sell beverages from <br /> Note: The only operationsd <br /> approved dispensers, P <br /> nd washing will be provided in my booth by the following methods: <br /> g. Approved water for drinking,utensil and ha1-1� <br /> pproved bottled water. <br /> ❑ On-site hose bib that is connected to a pct 1t%'� '•'«�`=� ce. <br /> ❑ Other(specify): —,, <br /> 7. Electricity is provided for my booth's use ' Yr•.: _ ., ` hot and cold holding of potentially hazardous <br /> 8, 1 am providing an accurate probe therrnai-,.etP �` � 4 r , <br /> foods during all times of booth operu'iL" <br /> g• I am providing the following hot temperate:�c��r��=I`����h�•rsr7t holding of all potentially hazardous foods above <br /> 135°F: ❑Steno&N, tol trays <br /> ❑Camp stove <br /> ❑ -:0 Steam table& lids <br /> Double steamer <br /> ❑Electric stove top ❑Other(specify) <br /> initially hazardous food ductsde: meats, tamales, cooked beans, rice, <br /> Note: Examples of Pote <br /> vegetables,potato salad,eggs,and dairy p <br /> 1868 E. Hazelton Avenue I Stockton, California 95208ge Tor 209 468-3420 IF209 464-0138 <br /> www.si TEMP EVENT APP <br /> ll <br /> EHO 1"2 <br /> 0701I <br />