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Environmental Health Department TEMPORARY FOOD VENDOR’S APPLICATION 1. 2. Address: Phone: 3.List food to be sold or given to the public: 4. 5. Other (specify): 6. On-site hose bib that is connected to a potable water source. 9. 7. 8. Other (specify): Electricity is provided for my booth’s use:®.Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids Other (specify) 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com EHD 16-02 Page 7 of 11 TEMP EVENT APP 07/3/17 SAN JOAQUIN - COUNTY- Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: J^kApproved bottled water. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. foods during all times of booth operation: j^Yes 0 No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ^SkCamp stove Double steamer Electric stove top meats, tamales, cooked beans, rice, 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 (3) weeks prior to this event. / / / I.Name of Event: f^^afefs): The following is information about my organization/business: Name of organization/business: O-? f feh&zLk p_b f Ca tT Alternate: I am providing food that is NOT prepared at home: PSYes No All food is prepared on-site or is from approved commercial facilities:\JYes No Name of facility: S (Phone: ( ) Address of facility: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ^S-A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food 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.