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i <br /> SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All 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 /> �&, <br /> 1. 1.Name of Event:��rl/� �!/f Date(s): _ZZ <br /> 2. The following is information about my organization/business: <br /> Name of organizabon/business:��?4S <br /> Address: <br /> Phone: ( �QGi ) �i1�j 7 Alternate: ( ) <br /> 3. List food to be sold or given to the public: l ri ,I n . Cin IL;v,, f 4(u-f 1-hi li(�I(l.S, Ijb —�,t l <br /> M� s r�l�-c�- ; 5 4"d.L�� VU'Cis, <br /> 4. 1 am providing food that is NOT prepared at home:FA ❑ No <br /> All food is prepared -site or is ffom approved commercial fag1hione: <br /> Yes❑ No <br /> r Name of facility: lf � 0 G <br /> 71 <br /> Address of facility: 4 PM <br /> 5. 1 am providing a booth with the Wowing: (to protect my unpa kaged food and food-preparation areas from flies, <br /> dust and the public) <br /> XA 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 /> ❑ Other(specify): <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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use:Q Yes ❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:R1 Yes❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Stemo&hotel trays <br /> ❑ Double steamer Steam table&lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 0713/17 <br />