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E\LJUAUUIN <br /> <br />Environmental Health Department <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: A (yUI -tilt real <br />The following is information about my organization/business: <br />Name of organization/business: ao-ryt Kafte &)14/1, <br />Address: <br />Phone: (91 ) 74'2 -97Th' <br />List food to be sold or given to the public: <br /> <br />Alternate: ( <br /> <br />)4:co-le aam, cak-t9S Cernd92-5 <br />I am providing food that is NOT prepared at home: Yes E No <br />All food is prepared on-site or i from approved commercial facilities: <br />Name of facility: 1 -464' S:fir-e <br />Address of facility: 1-#3 r atelerei A Ea Gli f <br />Yes 0 No <br />Phone: (711) .2771 <br /> <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 />%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 />Other (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 />,,proved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />Electricity is provided for my booth's use' 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: es E No <br />I am providing the following hot temperat re control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove Sterno & hotel trays <br />Double steamer <br /> 0 Steam table & lids <br />Electric stove top zErOther (specify) -Wen. <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 I Stockton. California 95205 I T 209 468-3420 I F 209 464-0138 I www.siaov ora/ehd <br />END 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />Date(s): 0//011/4.