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- �'��.s+��w:-KYc1.7sai\ihaaau.�.L.A\i"i'�i� •�.M17i_t.�.=..•s:�1W:uacMw�r.�a.sn►T-.+.wwM�ra��+.��—._ <br /> SON JOAQUIN Environmental Health Depailrnent <br /> .0�1 i--1 i Y <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> I <br /> he festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: , 1-zea F Date(*): <br /> 2. The folowing is infomiation about my organizationfbusiness; <br /> Name of organization:business: /. L- /T. % / r�r�r✓ vry <br /> Address: <7o,r w/' V6/,a i <br /> Phone_ I's Alternate:( ) <br /> 3. Liss food to be sold or given to the public: '/v <br /> 4. t an}providing food that is NOT prepared at home: Yes❑No <br /> Ali fond is prepared on-site or is from approved commercial facilities:W Yes❑No <br /> Name of facility: •-rtT-. . rTCtOJ Phone: <br /> Address of facility: r'/7 7 'g.�' <br /> 5. 1 a,:,i prm4ding a bceth with the following:(to protect my unpackagad food and food-preparation areas from flies. <br /> dust and the public) <br /> 0 f, arr!?ceilin,constructed of either wood,canvas, plastic, similar material and fine mesh fly <br /> screening, completely 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 frcm the public. <br /> Other(specify): `Jrlrr �:aT� J 14 t• � .¢�ffJ <br /> Note: The or11y nner®tions not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources, <br /> I <br /> 6. ^pprcved vrater for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> F�On-site hose bin that is connected to a potable water source, <br /> R Other(specify), 'J• a 1��,7�JL. LZ,-41- -3'�--r' _ <br /> 7_ Electricity is provided for my booth's use:❑Yes b-,�No <br /> a. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation;❑YesIN No <br /> am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1's5'F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> D Electric stave top A 01her(specify) pi <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> i868 E.Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 f F- 209 464-0138 1 www.sjcehd.com <br /> EHD 1C-Ui F=a3n 7 of 1; S E�.1P Ey['i7 k�+P <br /> 07.a77 <br />