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.6t SANAOAQUIN <br />DocuSign Envelope ID A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />4WINNWrii <br />REC-008 <br />Environmental Health Department <br />No <br />asure the hot and cold holding of potentially hazardous <br />the hot holding of all potentially hazardous foods above <br />COUNTY <br />Greatnecs 9rows flc <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />0 - <br />tro!• <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. -1-- <br />1.Name of Event: Kite Festivp -j- -f- •/// il 1 / <br />P/JC .;t7 - k (2,0-Z,re -e'/111/ iiiir 4v-ril l Htt61 Jet, Date(s): 6 )c-:.24 <br />-7. ...o. 2y <br />The following is information about my organization/business: g- - i "7- ..Ly <br />Name of organization/business: /17-7 / '7;1 hyAri _—.2-___ <br />,i Q.5--?3 <br />Phone: /7 3 - Y -2) Alternate: ,57Q /2 <br />List food to be sold or given to the public: 7/Ze-12c-"ti <br />I am providing food that is NOT prepared at home:ViYesDo <br />All food is prepared on-site or is from approved commercial facilities:EYes <br />Name of facility: <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 />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />ing, 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 />Dther (specify): <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 />1.-Approved bottled water. <br />E n-site hose bib that is connected to a potable water source. <br /> <br />(specify): <br />aticrty is provided for my booth's use <br />her <br />I am providing an accurate probe the <br />foods during all times of booth operation <br />I am providing the following hot temperatu <br />R5°F: <br />amp stove <br />ouble steamer <br />lectric stove top <br />I l! terno & hotel trays <br />team table & lids <br />,, <br />her (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked <br />vegetables, potato salad, eggs, and dairy products. <br />beans, rice, <br />1868 E. Hazeiton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.crglefid <br />rilD 1B-02 Page 7of 11 TEMP EVENT APP <br />0619119 <br />Address: J-3 / 4 1. 245(.) cc, <br />Phone: