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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): ^/z/X 6I.Name of Event: 1. <br />2. <br />-g C <br />Phone: <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />9. <br />meats, tamales, cooked beans, rice, <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 />^0^terno & hotel trays <br /> Steam table & lids <br />ETbther (specify) <br />7. <br />8. <br />^*^.pproved bottled water. <br />hose bib that is connected to a potable water source. <br />1868 E. Hazelton Avenue | Stockton, California 95205 j T 209 468-3420 [ F 209 464-0138 { www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />The following is information about my onganization/business: <br />-x SAN JOAQUIN <br />COUNTY <br />J ______________________ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />AH 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 to this event. <br /> Other (specify):_______________________________________________ <br />Electricity is provided for my booth’s use: 0 Yes 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: Q 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 />j^Camp stove <br /> Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: 0*Yes No <br />All food is prepared on-site or is from approved commercial facilities:PTYes No <br />Name of facility: .Phone: <br />Address of facility: _________________-■— <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />B'X'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 />-Brother (specify): <br />Alternate: Q-o Z <br />Name of organization/business: <br />Address: <br />List food to be sold or given to the public: