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S A N J Q A Q U I N Environmental Health Department COUNITY— TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this eevent.1. 1.Name of Event:��,_ � G \y_ Oate(s): 2. The following is information about my organ izationlbusiness: 1 Name of organization/business:_ Drea's Kitchen _ Address: fVVA I04nu l Phone: ( ) l - ( (` Alternate:( ) 3. List food to be sold or given to the public: 1 t DK- .�D( ax l�v ke--%: �1 4. lam providing food that is N47 prepared at home:[]Yes VIN, CVQ All food is prepared on-site or is from a roved commercial facilities:❑Yes L NG Name of facility: rV r Phone: Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) El A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, 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): Note: The only operations not required to provide enclosed booths are those which set[ beverages from approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. ❑On-site hose bib that is connected to a potable w ter source. ]Other(specify): Oct QQ(_ 7. Electricity is provided for my ooth's use: ❑Yes[j No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all tunes of booth operation:❑Yes[I No 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135`F: ❑camp stove ❑Sterno&hotel trays ❑Double steamer ❑Steam table&lids ❑Electric stove top Wither(specify) Pfeil �J ed Note_ Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products- 1868 E. Hazeiton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHO 18-02 Pape 7 of 1l TEMP EVENT APP a7W17