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u 4 e" :1: I rl1Td{1 'S T9 :if7tTro f1S 1"S'a4D.�t"C 6 3951 16_, s, 1. T`WW 0'&a 'a r S A NJ Q A Q Environmental Health Department aA !" ....—COU `ITY ...... t,! `: ,_,,,,;'`_ �r�prnC-ss gru,:•s hcrc. ` TEMPORARY FOOD VENDOR'S APPLICATION t� 4 Ail food vendors(both for profit and non-profit)are required in return a signed and completed copy of this the.-Ust to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event�—��.+ ��Yt C `r c� pate(s): FD—�L- ! 2. Thefoliowing is information about my organization/business: Name of organizatien/business: -- Address: Phone: ( )) � � Altemate:( ) 3, lust food to be sold or given to the public: 4. I am providing food that is NOT prepared at horle:❑Yes ZI-No All food is prepared on-site or is froin approved commercial facilities:❑Yes 1�5Ao Name of facility: _ Fhcne:( 1 Address of facility: 5, t am providing a booth with the following:(to protect my unpackaged food and fccd-preparation areas from flies, dust and the public) $4A booth with walls and ceiling constructed of either wccd, 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 carps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the pubic. Ej Other(specify): 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): 7. Electricity is provided for my booth's use: ❑Yes Ito 8. 1 a)n providing an accurate probe tliermorrieter to measure the hot and cold holding of potentially hazardous foods during all times of booth operaVon: ❑Yes❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135'F, Canip stove ❑Sterno&hotel trays ❑Double steamer ❑Steam table&lids ❑Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. 1868 E.Hazelton Avenue( Stockton, California 952051 T 209 468-3420 1 F 209 464-0139 j vPjvw.sjcehd_com 1=Ha'16-07 page 7 of 11 TEMP FVENT APP 07t3117