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.�, S A N ,:J OA Q U I N EnvirronmenW Health Department COUIJTY S�.u. ;�" Gre(iIr)-,S5 (if',. t hci'rr. 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 poorr to this event. )� I '€.Name of Event: L�,G, t Date(s): 2. The following is information about my organization/business: Name of organization/business: 14u lq I kS &Avelli Address: "� '9 ° Poe �'`? L� 'q 1, - q 7� Phone: { �O) — 3 Alternate:(6 �L 1�3 5 3. List food to be sold or giv n to the publi • G �!�O-10 a4 rll? d �i✓.�,. 4. 1 am providing food that is NOT prepared at home: ❑Yes❑ No All food is prepared on-site or is from approved commercial facilities:0/yes❑ No Name of facility: H u im f 4l q � I AWZ Phone: 1 a 3 1 d3 S Address of facility: L��-q apdp Vle i L l S 5. 1 am providing a booth with the following: (to protect my uneackaged food and food-preparation areas from flies, dust and the public) ❑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. ! f Vo-ther(specify): f �� { 'lao Note: The only operations not required to provide enclosed booths are those which sell 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 water source. [other(specify): f f'ct M 7, Electricity is provided for my booth's use:❑Yes No 8. 1 am providing an accurate probe thermometg`to measure the�ot Arid cold holdii g of potentially hazardous foods during all times of booth operation: KI Yes El No (� i mil 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 9 35°F: ❑ camp stove ❑ Sterno&hotel trays ❑ Double steamer ❑ Steam table&lids / (Ale El Electric stove top Other(specify) /�/14 Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicelid.com can 1 A.A.) Pape 7 of i 9 TEMP EVENT APP