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r-1 SANAOAQUIN ' Environmental H 6 `�` +I pa men COUNTY-- TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to reWrIl a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event, 1. 1.Name of Event: ,'��i n/e- E�[~i✓f _ Date(s): 2� Z 2. The following is information about my organization/business: Name of organizationlbusiness: 2�� _ Address: ' Phone: 011 Alternate: ) 3. List food to be sold or given to the ubl'sc: / a P i am providing Food that is NOT prepared at home:,PTYes❑ No All food is prepared or-s a or issf from approved commercial facilities: les E] No Name of facility- �i Aejd( 4--C ��v/Phone: Address of facility..- 2361 G05QS 5. f am providing a booth with the following: (to protect my unpac food and food-preparation areas from flies, dust and the public) <A A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly s� creeping, 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): r Note: The only operations not required to provide enclosed booths are those which sell beverages from 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: �7proved J)ouled water. j]on-site hose bib that is connected to a potable water sourer:. ij Other(specify). �5 S --- 7- Electricity is provided for my booth's use: ❑ Yes Q No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 2`Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑Camp stove Xsterno & hotel trays ❑Double steamer ❑ Steam table & lids Q Electric stove top �ther(specify) C y,01•11etdeS Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. '1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I �v4vw•s1TEMp OrgENTAIP �•: EHO 16-02 Page 7 of 11 06129/2023 TEMP EVENT W'P n ri/V 41 V 11' nai�ar�nn .