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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />9. <br />meats, tamales, cooked beans, rice, <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 />7. <br />8. <br />135T: <br />■fSttCamp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />C. 01.1 N T Y <br />All food vendors (both for profit and non-profit) are <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | wwwsjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />ntnHT <br />, . , . . required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />TName of Event WtH PM Dafefs): <br />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />S Other (specify): U)| UWaMuWI <br />Electricity is provided for my booth’s use: Yes 0 No * (J <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: Q Yes No - < <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br />S Steam table & lids <br /> Other (specify) <br />The following is information about my organization/business: <br />Name of organization/business: WftU <br />Address; <br />Phone: ( Alternate: ( ) <br />List food to be sold or given to the public:\/^'6]^t1^1^'l/^/ OUM/Vl <br />I am providing food that is NOT prepared at home:^ Yes No <br />All food is prepared on-site or is from approved commercial facilities:0^65 Q No <br />Name of facility: frA D TDD UVW f IS IPhone: ( <br />Address of facility: D filh I fl) W hY 4^ CA <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 />^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.