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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />^-7" 2?Dale(s):I.Name of Event1, <br />2. <br />Address. <br />Phone: <br />3. <br />4. <br />f/t: C<.y\ <br />5. <br /> Otliort specify): <br />6. <br />9. <br />moats, tamales, cooked beans, rice, <br />1666 £ Hazelton Avartue | Stockton. California 95-205 | T 209 468-3420 | F 209 464-01.36 | www.sjgov.org/ehd <br />tHD 1M2 Pag« 7 «f 11 temp event app <br />0W?9®K3 <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 />7. <br />8. <br />Q Sterno &. hotel trays <br />O Steam table & bds <br /> Other (specify) <br />SAN JOAQUIN <br />—COUNTY <br />/h/ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^^Approved bottled water <br />[Z] On-site hose bib that is connected to a potable water source. <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 throe (3) weeks prior Io this event. <br />Note; Examples of potentially hazardous food include; <br />vegetables, potato salad, eggs, and dairy products. <br />Tj^A booth with walls and ceiling constructed of either wood, canvas, plastic, simitar material and fine mesh fly <br />screening, completely enclosing open food areas. II 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 />_ Alternate: (T <br />Q <br />Q Other (specify); _ <br />Electricity is provided for my booth’s use' Yes 13^No <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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135'F: <br />Q Cam p stove <br />O Double steamer <br /> Electric stove top <br />/z*> c>/ <br />/ <br />The following is Information about my organ Ization/buslness: <br />Name of orgamzation/business '/(■W ''j Ly-/q lc-vh> fi(r' <br />2 0 Oa-PCee <br />(Zc^l ) ___ <br />List food to be sold o-r given to the public: <br />I am providing food that Is NOT prepared at home: YesNo <br />All food Is prepared on-site or is from approved commercial facilities:^] Yes No <br />Name of facility: Tk? ni Phone: (/rX? ) 2 \7- ic>6^ <br />Address of facility: P C fn K C ~^-l All Zt? C <br />I am providing a booth with the following (to protect my unpackacjed food and food-preparation areas from flies, <br />dust and the public)