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. 4 <br /> SAN JOAQVIN COUNTY <br /> lz <� ENVIORMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue Stockton Cali'�'�•:;: �` forma 95205 <br /> � :<: -... r' Business: (209) 468-3420 <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 <br /> checklist to the festival coordinator three (3) weeks prior to this event. <br /> 1. Name of Event: Date(s): D 2a <br /> 2. The following is information about},,y! rganization/businessz� <br /> Name of organization/business: <br /> Address: IL 4� A j3. N <br /> Phone: 6 3 — .3 W,Y Alternate: <br /> 3. List food to be sold or given to the public: !� <br /> L� � �'4, ������ ��� �z-tG.t�-G..� ="mil�1J t•�S{� ��� a(`E� <br /> 4. I am providing food that is NOT prepared at home: [✓f Yes [ ] No <br /> All food is prepared on-site or is from approved commercial facilities: [A-Yes [ ] No <br /> Name of facility: Phone: <br /> Address of facility: t3 1` f_4j. - _ j j 6v�C � d � < <br /> 5. I am providing a booth with�t e following: (to protect my unpackaged food and food-preparation areas from <br /> flies, dust and the public) <br /> [1] 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 /> V) Other(specify): <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 <br /> methods: <br /> [� Approved bottled water. <br /> [vj On-site hose bib that is connected to a potable water source. <br /> [vi Other(specify): <br /> 7. Electricity is provided for my booth's use: [�1Yes [ ] do <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: [✓r Yes [ ] \o <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 /> [v]''Camp Stove [ ] Double steamer [ ] Electric stove top /J <br /> [%,fSterno &hotel trays [ ] Steam table & lids [�j Other(specify): f t C <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br /> potato salad, eggs and dairy products. <br /> Page 5 of 6 <br />