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SAN JOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY <br />Grentrris her <br />TEMPORARY FOOD VENDOR'S APPLICATION <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 />1.Name of Event: I. r Ckf I C /- Date(s): 0c4- Ii 111 <br />The following is information about my organization/business: <br />Name of organization/business: (Awl ns 11 (Ai eve_ Lobs Fa <br />Address: f) ( <br /> <br />(11 LI L,.cj 2 <br /> <br />Phone: ( 11 6 ) o - Lb 711 Alternate: ( ) <br />List food to be sold or given to the public: <br /> <br />Meru+ A tfo LAI d , <br /> <br />I am providing food that is NOT prepared at home: e('es El No <br />All food is prepared on-site or is from approved comm rcial facilities: 0 Yes El No <br />Name of facility: Ist)11 rt rtp ckg. (rn FYAA tlPh on e: <br /> <br />Address of facility: <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 />E] 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 /> <br />Other (specify): FO cTroll <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />D Approved bottled water. <br />El On-site hose bib that is connected to a potable water source. <br /> <br />LIZOther (specify): Pu d erfAktle- y <br />Electricity is provided for my booth's use: er Yes 0 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:241'es 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove <br />/Double steamer <br />Electric stove top <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />OG/29/2023 <br />(r); kzI coo .111--y <br />D Sterno & hotel trays <br />,_.Steam table & lids <br />Other (specify) s o u p fiA!-qii_s <br />Scanned with Can,Scannor