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Environmental Health Department All food vendors (both for profit and non-profit) River Islands Certified Farmers' Market1.Date(s): Saturdays 8:30 to 12:30 2. Address: Phone: 3. 4. 5. those which sell beverages from 6. 9. meats, tamales, cooked beans, rice, 5 8.’ SAN JOAOUIN ------COUNTY------- Grectness grows here. TEMPORARY FOOD VENDOR’S APPLICATION 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www sicehd com 07/^T02 Page7of11 TEMP EVENT APR Note: The only operations not required to provide enclosed booths are approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. I.Name of Event: The following is information about my organization/business: MOW)__________ WV\Vy\A Cft <TS>uQ Alternate: ( j [ (j ) <U0- UK) LU On-site hose bib that is connected to a potable water source. Other (specify):______________ z, Electricity is provided for my booth’s use: Yes^J No I am providing an accurate probe thermometet^measure the hot and cold holding of potentially hazardous foods during all times of booth operation/'fjYes O No I am providing the following hot temperaturbcontrol for the hot holding of all potentially hazardous foods above Camp stove Stemo & hotel trays Double steamer Steam table & lids Electric stove top Other (specify) Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. t . ) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Name of organization/business: UM- Y'SA •SIG)—JiL—LLL. List food to be sold or given to the public: I am providing food that is NOT prepared at horned Yes No All food is prepared on-site or is from approyed.cdmmercial facilities: Yes No Name of facility: \ VA vy \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) Q-ATiooth 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. Other (specify):____