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S A N J O A Q U 1 N Envier"onmental Health Department �- TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit) are required to return a s}gned and completed copy of this checklist t?�� the festival coordinator three(3)weeks prior to this event.., /`� {,-{)'1 Z0 1. 1.NameofEvent:' Tye J Date(s) 2_ The following is information about my organ ation/business fj~ Name of organizationi'business Address: 9,0 J> Phone: (911k) Alternate: 3. List food to be sold or given to the public: 4. t am providing food that is NOT prepared at home.❑Yes td No At food is prepared on-site or is from approved commercial fablities: ❑Yes E //No Name of facility: Phone:( } Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas frorn,iF- dust and the public) ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine r7esr screening, campletely enclosing open food areas. It will also have a smooth and cleanable floor (ccncr,t, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preeca7aticr areas from the public. Miner(specify): r ` Note: The only operations not required t provide enclosed booths are those wNcn sell approved dispensers, or prepackaged foods from approved sources. S. Approved water for drinking, utensil and hand washing will be provided in my booth by the folic,``, ..g n'e^cds ❑Approved bottled water_ On-site hose bib that is connected to a potaUe water source. O/Other(specify) i � i� -� � 7_ Electricity is provided'foi my booth's use ❑Yes�o B. I am providing an accurate probe thermometer to me-sitre the hot and cold hoot ing of po�ten sally hazardous foods during all times of booth operation ❑ Yes No 9. 1 am providing the following hot temperature control fo: leer+ lint holding of all potentially hazardous foals above 135"F: ❑Camp stove ❑ Sterno&hotel hays ❑Double steamer L] Steam table&lids f I) " ❑Electric her stove top U Other(specify)(specify) V v 1J l ' Note: Examples of potentially hazardous food 111CIUde: ineats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. 1868 E.HweMh Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 \+<mw.sjcehd.com Etipt6.02 Page 7ol it TU.10 EvrNI AWi otrsrss I i