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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: 1. <br />2. <br />Address: <br />3. <br />4. <br />5 <br /> Other (specify): <br />6. <br />9 <br />( /km l <br />meats, tamales, cooked beans, rice, <br />EVHNT APP <br />=1 <br />I <br />I <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />,0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <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 Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> <br />SAN JOAQUIN <br />------COUNTY <br />Alternate: (2^ ) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHO 16-02 Page 7 of 11 K.™ ,*J <br />06/23/2023 <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 />Fl Camp stove <br /> Double steamer <br /> Electric stove top <br />the festival coordinator three (3) weeks pi <br /> Other (specify):_______________________________________________ <br />Electricity is provided for my booth’s useJETYes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />f <br />Dato(s): I ~ <br />I <br />t | <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />•rkv to this event. . <br />/ i^A/a <br />The following is information about my organization/business^ <br />Name of organization/business lUzWi UpX-i/rzn <br />Phone: ) 3^lp ' 3 <7 (u , <br />List food to be sold or given to the public:IZT/OX PjUtv x V A <br />I am providing food that is NOT prepared at home. 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: ET?es No <br />Name of facility:Phone: (1 <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 />ATA 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.