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I <br />SAN JOAQUIN Environmental Health Department <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 />1.1. Name of Event <br />2. <br />Address- <br />Phone <^1 >) <br />3 List food to be sold or given to the public:a <br />4. <br />5 <br />Brother (specify): <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 />9 <br />7. <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 /> Other (specify): <br />Electricity is provided for my booth's use Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />Name of orgamzation/busmess <br />The following is information about my organization/business: <br />\c <2 7 Vo v <br />foods during all times of booth operation. ® Yes No <br />I am providing tie following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />I I Camp stove <br /> Double steamer <br /> Electric stove top <br />the festival coordinator three (3) weeks prior to this event. <br />y YcwnM 4-&ate(s). Q- \ <br /> 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 /> <br />meats, tamales, cooked beans, rice, <br /> Sterno & hotel trays <br /> Steam table & lids <br />[^.Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Alternate ( <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: 2? Yes FT hip ° <br />Name of facility (x <<JPC\. V S ? \A / /^k^ohe: ( ) <br />Address of facility _____ / (9^° <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)