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R EC-008 <br /> - S A N.,,J O A Q U I N Environmental Health Department <br /> COUIVTY— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food %,Vndors (bo:1 fo► prolit and non-profha are recu!rod to return a signed and competed oopy of this C:eckist to <br /> the lestval coordinator riree(3) weeks prior to this eticnt <br /> t. t Name of E.cr►:_ v,(,1_�r_ 0r — Daws): _ ISZPI <br /> 2. The to-lowing is Wormabon about my organ izaaonbLsness: <br /> Name of organ izatioonbussi,.ness: <br /> Address: T'L r I 1 I-, .I _ � � 7> 1� �11� ���, � �S(Q ,CA <br /> Phone: ��a - "7.� n G'19 Alternate: <br /> 3. List food to be so'd or given to the publx: n`t `-)e �i 1+"`fit+ ,t�h ' �� 1bS _1 rZ T:rut s ct <br /> 4. 1 am providng food thgtis NOT prepared at hyr-;-E1;D0 <br /> A9 food is prepay 4n sit- is from approved commem-al lacildies esDo <br /> Nacre of fac4 y: Phone: <br /> Address of facdsy: <br /> 5. 1 a.-n pro0ding a booth with the following:(lo proW my urpacicaged food and food-prcpartion areas from flies, <br /> dust and the pttlic) <br /> booth with walls and ceiling constructed of eaher wood. canvas, plastic,similar matcdal and line mesh Ily <br /> ing, comp!el,6y enclosing open food areas. It will also have a smooth and cleanable floor (concrete. <br /> as;Tat. clean tarps and smooth wood are acceptab:o) and con-structed to separate food and food preparation <br /> areas from the public. <br /> hcr(spct:fy): <br /> Note: The ony operations not repu'red to pro%ide enclosed booths are those which self beverages from <br /> approved dispensers,or prepackaged foods from approved sources <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Dri-site hose bb that is connected to a potable water source, r \ <br /> her(specfy):j �)Z '1t1,P V�„_ ,,,"MrIne <br /> t ^tom ��r'n f l�1 Y <br /> 7. deity is prov'ded for my booth's use 8 I am providing an accurate probe thesure the hot and cold hdding of potentially hazardousfoods during all times of booth operation0 <br /> 9. 1 vn providing the fol:owing hot temperat hot hW;ng of all potentially hazardous loods above <br /> 5°F: <br /> amp stare Sterno& hotel trays <br /> oub'e steamer Stearn table &I <br /> �,.., b\ncYtitc,� cn-�.c.�4,r ,S�SC�c �cft7 <br /> Iectric stove top .her(spCCily) «.� ��tl . :\n�=•^,� `d,��s >1 -hoc <br /> Note: Examples of poteritlally hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazetton Avcnue I Stockton,California 95205 T 209 468-3420 1 F 209 464.0138 1 www'.sigov.org/ehd <br /> Pr,:7 co Mp E*.FW APP <br /> 'Xti'•`►19 <br /> Scanned with CamScanner <br />