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l � <br /> S A N J 0 AQ U j N Environmental Health Department <br /> COUNTY--- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Ali food vendors (both for.profit and non-profit)are required to return a slgned and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. \Z 3 Z <br /> 1. 1. Name of Event:C � Dix <br /> pate(e) <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organizationtbusiness: ` <br /> ri <br /> Address: <br /> Phone: (��� ) <br /> Altemate: <br /> 3. List food to be,sold or given to thO public: <br /> 4. 1 am providing food that is NOT prepared at home Yes[]No <br /> All food is prepared on-site or's fro approved commercial facilitiesYes❑ No <br /> Name of facility. Phone. _ <br /> S <br /> Address of facility: ration areas from flies, <br /> S. !am providing a booth with the o owing: to protect my unpackage food and food-preps <br /> dust and the public) <br /> ❑ A booth with walls and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly <br /> asp-screening,l, clean <br /> completely enclosing open area acceptable)It will <br /> and o have a smooth and constructedto separate food cleanable <br /> nd foodr(preparation <br /> asphalt, clean tarps and smooth wood are accep ) <br /> areas from the public. <br /> other(specify): 2. <br /> Note:The only operafions not required to prod fiords from app o ed sources.de enclosed bths are those which sell beverages from <br /> approved dispensers, p p <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> 2r�Approved bottled water. <br /> ❑pis-sine hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: es No <br /> 8. I am providing an accurate probe thermorn er to measure the hot and cold holding of potentially hazardous <br /> 9 foods during all times of booth operation- Yes❑ No <br /> I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> ❑Camp st ove ❑Stemo&hotel trays Steam table& lids <br /> ❑ Double steamer ❑other(specify) <br /> electric stove top ❑ <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 I Stockton, California 952051 T 209 468-3420 I IF 209 464-0138 J www.sjgo� rg1eh�d�P <br /> _tin 16-02 Page 7 M 11 <br /> i7K 11,094 <br />