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S A N J O A Q U I N Environmental Health Department COUNTY TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy or,'this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: ' l �T r �!n` t 'r/ ' !r Cafe(s): 2. The following is information about organizationhwsines� i r Name of organizatiio'n1business { 1 •� Address: , Phone: i Alternate:( ) 3. List food to be sold or given to the public: 4. 1 am providing food that is NOT prepared at home:,�rYes❑No All food is prepared on4te or is from approved commercial f2cilities:7c]Yes❑No lame of facility: Phone:a_7[ Address of faeiIity.,?� �} _ � ,^ .' -.a !i 4�� << < - �r 7 5. 1 am providing a booth with the tollowing:(to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with walls and ceiling constructed of ether wood, canvas, plastic,similar material and fine mesh fly =eening, completely enclosing open food areas. It will also have a smooth and cleanable floor(concrete, asphalt,dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other(specify): rL - 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 Trashing will be provided in my booth by the folloWng methods: ❑Approved bottled water. ❑On-site hose bib that is connected to a potable water source. SQ Qther(specify);/'' f' r✓ r <A 7. E3ectricity is provided for my booth's use:❑Yes❑No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:❑Yes❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑Camp stove ❑Stemo&hotel trays #.� ❑Double steamer ❑Steam table&lids - ❑Electric stove top ❑Other(specify) i Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. 1863 E.Hazelion Avenue; Stockton,California 952051 T 2fl9 468-3420 1 F 209 464-0138 ] www.sjcehd,com EHP 1"2 PxigC 7 of 11 TEMP EVENT APP 07/V17