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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both tor profit and non-profit) are required to return a signed and completed copy of this checklist to <br />Address: <br />Phone <br />5 <br />6 <br />9 <br />____~ 0 <br />LJ Yes|.iNo <br />Approved water for drinking, utensil and hand washing will be provided <br />I J Approved bottled water <br />www sjgov org/ehd <br />’ CMF i '.'I M r .■'■i-r' <br />8 <br />_^x).SfZiL <br />.lixtttXLfe-v..C A- - <br />SAN JOAQUIN <br />in my booth try the foltowing methods. <br />? I ry i It-bA <br />i. I On-site hose bib that is connected io a potable water source <br />® Other (specify) ( pf V < /.)lieI 114 A <br />h lectncify is provided for my booth's use Q Yes j j No ~ ''■3 ... <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods durinci all times ot booth operation' [...J Yes Q No <br />I am providing the following hot temperature control lor the hot holding ot all potentialiv hazamous foods above <br />135'1 ' <br />I I Camp stove [ J Sterno & hotel trays <br />y Double steamer [Sj Steam table & lids <br />I><1 Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Address of facility J Lt S-TfV'zq-j ' <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 />meats, tamales, cooked beans, rice, <br />.he c£4........................, ..35iA, l.......... <br />..... Alternate. ( 7^y )C|.7_P._r /j.'L'h <br />I.ist food to be sold or given to the public: ..Mt <br />I am providing food that is NOT prepared at home: Yes Q No <br />All food is prepared on-srte or is from apptoved^omrnercial facilities. Q-Yes [ ’ ! No <br />Name of facility <br />the festival coordinator three (3) weeks prior to this event. <br />T Name of Event..Date(s): ...i.S.../...J?Z <br />The following is information about, my organization/business. <br />Name of organization/business: 1 <br />luZ__Vxsov-> <br />1 2<?a j.... <br />mf-to !■ Hazelton Avenue | Stockton. California 95205 I T ?09 468-3420 | F 209 464-0138 I <br />l9'<D16 0-- p, . , (it , ' " - .... 1 <br />[..,., A 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 prapaiution <br />areas from the public <br />Sfloiherisperfy, /.Vify ,(^nAvnr4 ftr.l i¥v.ux,j TlfryAj Wpv.-.-.-e.A .V..I rWv .s.'„ <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.