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SAW10ANIN Environmental Health_ Department <br /> __COON <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 there(3)weeks prior to this event. <br /> 1_ 1.Name of Event- Date(s): <br /> 2. The following is information about my organ izationlbusiness: <br /> Name of organizabonlbusiness: <br /> Address �ct+'Ct. iNn Q, 5-r; c.ems¢ CA- 5_�,3 Mci <br /> r <br /> Phone: ( ) '�-��}�— 3 Aftemate:( ) <br /> 3. List food to be sold or given to the public: `ECG <br /> 4. 1 am providing food that is NOT prepared at home. ❑No . <br /> All food is prepared on-site or is from approved commercial facilities:[2"Yes[INo <br /> Name of facility. C ap'&o w-- ,� Phone:( 53Q3 <br /> Address of facri'dy: 'Z'"1 — <br /> +�; 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> El A booth with walls and cei5nj 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 /> 1 <br /> ❑ Other(specify): <br /> C <br /> 7 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 /> u <br /> k <br /> { ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> E <br /> 7 <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use:❑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:❑Yes❑No <br /> 9. 1 am providing the foriowing hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135T.- <br /> ❑Camp stove ❑Stemo&hotel trays <br /> ❑ Double steamer ❑Steam table&rids <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 [ Stockton, Califomia 95205 ] T 209 468-3420 1 P 209 464-0138 1 www-sjcehd.com <br /> E-!D 16-02 Page 7 of i1 <br /> 07/3/17 TEMP EVENT APP <br />