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Environmental Health Department <br /> <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 />gf/u r^'-tot Name of Event Dateisi <br />2 <br />Address <br />Phone ) <br />3 <br />4 <br />5 <br /> Other (specify) <br />6 <br />O On-site hose bib that is connected to a potable water source <br />9 <br />meats, tamates. cooked beans, nee. <br />2^Yes No <br />Phone !___ <br />I am i <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />8 <br />J Yes No <br />10 ^easure the hot and cold holding of potentially <br />SAN JOAQUIN <br />—'COUNTY— <br />'wfA booth with wafts and ceiling constructed of either wood canvas plastic similar materia* and fine mesn fly <br />screening completely enclosing open food areas It will also nave 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 />Note: Examples of potentially hazardous food include <br />vegetables, potato salad, eggs, and dairy products <br /> Other (specify) _____ Electricity is provided for my booth s use <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 Q No <br />providing the following hot temperature control for the hot holding of an potentially hazardous foods above <br />(ZlStemo & hotel trays <br />fl Steam table & lids <br />Q Other (specify ; <br />Note: The only operations not required-to provide enclosed booths are those which sell beverages from <br />approved d'Spensers, or prepackaged foods from approved sources <br />__ Alternate ( <br />I am providing food that is NOT prepared at home O'Yes O No <br />All food is prepared on site or is from approved commercial facilities <br />Name of facility Hf? > Phone { i_________________ <br />Address of facility f ____„ <br />l am provding a sooth with the following (to protect my unpackaged food and food-preparation areas from fires. <br />dust and the public) <br />Name of organization/busmess __ <br />. "V/9*9? / 11 <br />(^.0$') 25113^______ <br />List food to be sold or given to the public <br />1868 E Hazelton Avenue 1 Stockton. California 95205 T 09 4 - .<47; <br />ErtO i»-O2 p»9« r o(11 <br />the festival coordinator three (3) weeks prior to this event <br />The following is information about my organization/busmess <br />Approved water for drinking utensil and hand washing wifi be provided m my booth by the following methods <br />Approved bottled water <br />F 209 464.0138 | www sjgov org/ehd <br />UM® EVE >s 1 APP