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Environmental Health Department <br />1.1. Name of Event: <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />E Approved bottled water. <br />7. <br />8. <br />SANJOAfjIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sicehd.com <br />1T02 Page 7 of 11 TEMP EVEN! <br />U i /«j/1 l <br />. ■ <br />I'- n- ; ■' ■" 1) <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 />[^Other (specify): <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 />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 />JAMUIAL TAMAllL t&SiAL Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: <br />loVSb SV Tzc ^63/$_________________ <br />( 20^1) u Alternate: ) 47/^4 <br />UZLS f V\ <br />I am providing food that is NOT prepared at home: Ej Yes No <br />All food is prepared on-site or is from approved commercial facilities: [J^Yes No <br />Name of facility: C fZH Phone: (7-^)^ I "Z <br />Address of facility^^n*"!^ bV CA <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 />EjS On-site hose bib that is connected to a potable water source. <br /> Other (specify):________________ <br />Electricity is provided for my booth’s use: Q-Yes No <br />I am providing an accurate probe thermorneter to measure the hot and cold holding of potentially hazardous <br />foods during al! times of booth operation: 0 Yes No <br />1 ^Providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove Q Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify)