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Environmental Health Department <br />All food vendors (both for profit and non-profit) <br />River Islands Certified Farmers' Market1.Date(s): Saturdays 8:30 to 12:30 <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY------ <br />GreoCness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />)___________ <br />Alternate: (f2^ ) 72-^ — 7 <br />AJisvl _______ <br />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: Cf/kO <br />If? 76 <br />(W )_6it0_2^O£_________ <br />List food to be sold or given to the public: £> r? J <br />ehd6?6-o2 Hazeltori Avenue 1 Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 Pa9® 7 Of 11 TEMP EVENT APP <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />I am providing food that is NOT prepared at home: ETYes 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:______________ _________ <br />' ^s^andthe public)1 W'th fOllOWing: (t0 protect my unPacka9ed food and food-preparation areas from flies, <br />) 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 />0A 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 />areas fronTth0 ^'bf 306 Sm°Oth W0°d are accePtable) and constructed to separate food and food preparation <br /> Other (specify): <br />CTOn-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes EB'No " <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation: 0 Yes Q No <br />' p7°vidin9 the fo”owing hot temperature control for the hot holding of all potentially hazardous foods above <br />1 oO i . <br />Q'T-arnp stove I | Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.