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tom'- SAN-.--j0A0U1N Environmental deal _Department ---;=O U N -____ 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 j3)weeks prior to this event 1. 1.Name of Event:_. [�{�/�JG �-�//��jj Date(s): 2. The following is information about myorganizationlbusiness: Name of organization/business: tom`t ,,; y�y",•, Address: N\!� f tL c.ci Phone: Altemate:( ) 3. List food to be sold or given to the public. 4. l am providing food that is NOT prepared at home: ❑No All food is prepared on-site or is from approved commercial facilities:®'Yes❑No Name of facility. C Qr k--31 „ C-4:e- Phone:f Address of facni y. '. .,n b ,J:j�% 5_ 1 am providing a booth with the following.(to protect my unpackaged food and dust and the public) food-preparatfroml�' on areas from flies, sc A booth with webs and ceiling constructed of either wood, canvas, plastic,sjmjlar iriaterim and fsne mes-h fly screening, completely enclosing open flood 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. i Q Other(specify): t i Note: The only operations not required to provide enclosed booths are those which sell beverages 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: a Q Approved bottled water_ J Q On-site hose bib that is connected to a potable water source. Q Other(specs y)` 7. Electricity is provided for my booth's use:Q 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:Q Yes Q No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135'F: Q Camp stove Stemo&hotel trays ❑ Double steamer ❑ Steam table&lids ❑ Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. 1863 E Hazeltor venue I Stockton, Califomia 95205 j T 209 468-3420 j F 209 464-0138 � lsrw,,v.sjcehd.com 0713117 page 7 of 71 7EW EVENT APP