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( <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />Address- <br />Phone <br />3. <br />4. <br />1 <br />5 <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6. <br />Approved bottled water <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />TEMP EVENT APP <br />- <br />8 <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 /> Sterno & hotel trays <br /> Steam table & lids <br />^fother (specify) <br />SAN JOAQUIN <br />C O U N T Y- <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities <br />Name of facility: _____________________________________ <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 />0^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 <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 /> Other (specify): <br />Electricity is provided for my booth’s use. <br />I am providing an accurate probe thermometi <br />foods during all times of booth operation: 0* <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />1 _ __ , , , TCMD EA/CMT <br />EHD 16-02 Page/of. 1 ••— <br />rx~t <br />□ Yes Sz^No <br />to measure the hot and cold holding of potentially hazardous <br />Yes 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 <br /> Double steamer <br /> Electric stove top <br />^fves □ No <br />Phone: (___ <br />I.Name of Event: kV/e <br />The following is. information about my organization/business: <br />Name of organization/business: fA/-'1 <br />/€ 7^ / _________________ <br /> Alternate: ( ) <br />List food to be sold or given to the public: ~~ <br />meats, tamales, cooked beans, rice, <br />77^ Date(s): @