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SA Rd 0AOU N Environmental Health Department —COUNTY— Greatness grows here. TEMPORARY FOOD VENDOR'S APPLICATION All food venftm(both for profit and non-profit)are requked to-return a eigt(ed and completed copy of this chAQkM to the festival coordinator three(3)weeks prior to thisa/vent. 1 1— 1.Name ofEvent: F%ton P �^� &5!k R �Ukk Date(s):� �l�tf1 2. The following is information about my organization/business: i Name of organizadonlbusiness: C-tvCk4n Address:- l� c Phone: Altemate"": 3. List food to be sold or given to the publicCI 4. 1 am providing food that is NOT prepared at home: ]Yes[]No _ All food is preparers on-site or is from approved commercial facilities:]KYes[INo t Name of faatity 'ffb� C6 i�M<S Phone: a) 0 �0 Address of facility-. 10 tA SW5 &cie ( } fkLk'6"14 5. 1 am providing a booth with the Toll g:(to protect my unpackAged food and food-preparation areas frb€flies, dust and the public) / A booth wry walls and ceiling constructed of either wood,canvas, plastic, similar material and fine mesh fly _ ls�eening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt,dean tarps and smooth wood are acceptable)and constructed to separate food and food preparation areas from the public. - Otiier(specify)- Nldit:-The ordy operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking.utensil and hand washing will be provided In mybooth by the follov€ring methods: _ XAppraved bottled water. Orr-site hose bib that is connected to a potable water source. ❑00W(speefy): ' € 7.- Electricity is provided for my booth's use:❑Yes No B. 1 am providing an accurate probe thermon titer measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes[3 No " - 9. 1 am providing the following trot temperature control for the hot holding of all potentially hazardous foods above 135OF: ❑camp stove ._ ❑Sterno a hotel trays i NJ Double steamer - Steam table&lids 1 ❑Electric stove top ❑Other(specify) i Note: Examples of potentially hazardous food Include: meats, tamales, cooled beans, rice, vegetables,potato salad,eggs,and dalry products. _ 1868 E.Hazelton Avenue( Stockton,California 95205 t T 209 468-3420( F 209 464-0138 1 www.sjgov.org/ohd EHo 16402 Page 7 of n TEMP EVENT AP? uansr,a