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Environmental l-’ea^h t )e[K-Ament <br />TEMPORARY FOOD VENDOR’S APPLICATION. <br />I.Name of Event:1. <br />2. <br />Address: <br />Phone: <br />Zn^XLZzC^.a.3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify):_ _________________ <br />Note: The only operations not required to provide enclosed booths <br /> Approved bottled water. <br />^On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />AcAmpa, -— <br /> Alternate: ( 7^ )___ <br />List food to be sold or given to the public: <br />SAN WAIJUIN <br />- -COUNTY <br />Date(s): 13 ~~ <br />All food vendors (both for profit and non-profit) are <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd com <br />EHD 16-02 <br />07/3/17 <br /> Other (specify):——-----------------------------------------------——-------- <br />Electricity is provided for my booth’s use: HVes 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: )3k Yes L J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Sterno & hotel trays <br />Q Double steamer O Steam table & lids <br />Q Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Tn 4xZ( _Fdu/i. <br />The following is information about my organization/business: <br />Name of organization/business:. Op Lj -fap Ice Ct C-firr\ ------------- <br /> cA- AClirYTpd)_Oa—------ <br />__________ Alternate: ( )"'W- <br />I am providing food that is NOT prepared at home: [tfkYes No <br />All food is prepared on-site or is from approved commercial facilities: E>Yes No <br />Name of facility: -------------------------- ----------------------------------------- Phone. (-------L--------------------------------- - <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 />@,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 preparation <br />areas from the public.