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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 <br />Address <br />Phone: <br />ice ag^r^ , co\^'3. <br />4 <br />5. <br />those which sell beverages from <br />6. <br />9 <br />meats, tamales, cooked beans, rice, <br />7. <br />8 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />SANTAQUIN <br />t i ' I i M I \ <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />CA > <br />Alternate: ( <br />yTii nt C-ku/ros <br /> On-site hose bib that is connected to a potable water source <br /> Other (specify): <br />Electricity is provided for my booth’s use:^ Yes No <br />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: 0. 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 stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top 0Other (specify) ) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />a signed and completed copy of this checklist to <br /> DatefsJvJ1^^^ <br />All food vendors (both foi profit and non-profit) are required to return <br />the festival coordinator three (3) weeks prior to this event <br />1 Name of Event HoAlrtZi l/^al-(/rrcldn 54 <br />1 he following is information about my organization/business: <br />Name of organization/business: V L C C Ku f f OS <br />001 ) 5SV /_______ <br />List food to be sold or given to the public: ChUf f , f r H n I <br />I am providing food that is NOT prepared at home: j^Yes No <br />All food is prepared on-site or is from approved commercial facilities: j^Yes No <br />Name of facility: _______________ ______________________phone: ( ) <br />Address of facility:_ _________________________________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />f^A booth with walls and ceiling 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 from the public. <br /> Other (specify):_________________________ <br />■86^! Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www sjgov org/ehd <br />07/01/2024 PHae 7 °''1 TFMP EVENT APP