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SAN 10AQ U I N Environmental Health Department COUNTY— TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three � (3) weeks prior to this event. /� �} 1. 1. Name of Event l /[ Q J"s a�'1C i�t.hJ Date(s)-.06q L 2. The following is information about my organization/business: Name of organization/business: 6 X 5 CZLt tV J w`i5 U Address: Phone: (�� ) �f (� �� Alternate: 4r, 3. List food to be sold or given to the public: &✓ rA 6Z C_J�&S 4. 1 am providing food that is NOT prepared at home: j Yes ❑ No All food is prepared on-site or is from approved commercial facilities: ❑ Yes ❑ No Name of facility: ) ' '' � 2r `� < Oct i) -3 3 -L� G(. C .�. Phone: L Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food -preparation areas from flies, dust and the public) ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. �j Other (specify): LI )(/ l L' I ( Lys, Lva n ci oji ( tyl t,y lug --vim Note: The only operations not required to provide enclosed booths are those which sell b erages from approved dispensers, or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ,Approved bottled water. ❑ On-site hose bib that is connected to a potable water source. Other (specify): C- )0_ 1 10ilP, a 'A I ,% a lw K joucbl� St r1 L 7. Electricity is provided for my booth's use:1'Yes ❑ No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation; 6 }'Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑ Camp stove ❑ Sterno & hotel trays ❑ Double steamer ❑ Steam table & lids L' , ❑ Electric stove top ] Other (specify) gas Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 16-02 Page 7 of 11 TEMP EVENT APP 07/3/17