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h n RNl <br /> E nuiro ,y. <br /> nmental Health <br /> � SAN..JOAgUIN Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and nnn-profit) are required to return a signed and completed copy of this checklis! <br /> the festival coordinator three(3)weeks prior to this event. <br /> ;a <br /> � � , �r }: <br /> r, <br /> 1, 1-Name!of Cvent,�13.C.'�"T...f� r Date(s � <br /> 2" The following is infortnalion about cry organizationlbusiness; �s;q <br /> i Naive of organizaHcnlbusiness: <br /> Address: I i Co 2_jQerA- R05eu1 l re_,CA S 7 7 <br /> Phone: (91b ) <br /> l L Alternate:(q/6 )__7- [�'�� <br /> t I <br /> i <br /> 3. List food to be sold or given to the public.: <br /> 4. 1 am prmidinq food that is NOT prepared at hcme�es❑ No <br /> All foods prepared on-s.ite or is from approved commercial facilities; ❑Yes�Nc <br /> Name of facility: phone: ! ) <br /> Address cf facility: _- <br /> 5. 1 am providing a booth with the following.(to protect my unpackaged food and food-preparation areas from flies, <br /> dust a nd the public) <br /> ❑A booth with walls and ceiling constructed of either wood,canvas, plastic,similar material and fine mesh fly <br /> screanina, co:ripletely enclosing open food areas, it will also have a smooth and cleanable Floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> iher(specific): 16x/6 r <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources- <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ,ZApproved bottled water. <br /> ❑On-s'e hose bib that is connected 10 a potable water source" <br /> Other(specify): - <br /> 7. Oectrir,4y is provided for my booth's use:❑Ye No <br /> 8. 1 am,providing an accurate probe thermometer to rnrasure the not and.cold holding of potentially hazardous <br /> foods during all firn6s of booth'operation: yes �o <br /> 9, 1 am providing the fallowing hnt temperature control for the hot holding of all potentially hazardous foods above <br /> 135"F: Sterno&hotel trays <br /> camp stove ❑ ys <br /> Double steamer ❑Steam table&lids <br /> [� Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include-. meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue] Stockton, California 95205I 7 r 209 468-3420 1 F 209 464-0138 1 www.sjce 11 hdd.com <br /> ��n <br /> FHD 1E-02 Page <br /> 0713n 7 <br />