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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Kiver islands Certifted Farmers’ Market Date(s): Saturdays aau to i2au1.I.Nameof Event <br />2. <br />953,50 <br />3. <br />4. <br />|\J/ A PlLb & E£>oust ana me puoiic) <br /> Other (specify): <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />Noto: Examples of potentially hazardous food include:meats, tamales, cooked beans, rice, <br />7. <br />8. <br />ibbB b. Hazelton Avenue | Stockton, California 95205 | T 209 4tia-3420 | F 209 464-0138 | www.Sjcend.com <br />EH0 16-02 Paga 7 of 11 TEMP EVENT APP <br />07/3/17 <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 cieanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />«* •« ft* <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 /> Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />-----COUNTY------- <br />Electricity is provided for my booth's use. Yes S’No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />,35T: M/A <br /> Double steamer <br /> Electric stove top <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 />The following is information about my organization/business: <br />Name of organization/business: r~ ■ SouiLCoueiH <br />Isabella plAci; <br />Phone: ( ~ Alternate: ( ) <br />List food to be sold or given to the public: SOU^^QUfclH RiLE-AT) > PtlEAfCJ A . IcDLLS ,C00kJ5S <br />i am proviomq iooa mat is rrui prepareo at nome. l 1 res no <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility:Phone: ( ) <br />Address of facility: