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i i '� ' SA N�1 OA Q U 1 N Environmental Health Department ----COUNTY— c `r G:eerr+ess crows here. o� - TEMPORARY FOOD VENDOR'S APPLICATION Ail food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator th 3)weeks prior to this event me ` �0 -I�esV i T ( � , 1. 1.Na of Event {A�/„�,N Date(s) s) 2. The following is information about my organizatioNhusiness: Name of organizationtbusiness: Address: 1J S lCU Phone: Alternate: 3. list food to be sold or given to the public: 4. 1 am providing food that is NOT prepared at home:iJv Yes❑No // All food is preparreed4 on-she or is from approved commercial facilities:--Yes❑No Name of facility: ' X10 t f�1� Pone: Address of facility: 1 V E 5. 1 am providing a booth with the following:(it)protect my unpackaged food and food-preparati n areas from sties, dust and the public) ❑A booth with waits and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly screening, 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. e E Other(specify): Note: The only 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 my booth by the following methods: Approved bottled water. ❑on-site hose bib that is connected to a potable water source. ❑Other(specify): 7. FJectricity is provided for my booth's use:❑Yes o 8. 1 am providing an accurate probe thermometer to measure the hot and d holding of potentially hazardous foods during all times of booth operation:❑Yes❑No 9. 1 am providing the following hot temperature control for the hot holdin all potentially hazardous foods above . 135OF: ❑Camp stove ❑Stemo&hotel trays ❑Double steamer ❑Steam table&lids ❑Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beasts, rice, vegetables,potato salad,eggs,and dalry products. 1868 E.iiazelion Avenue I Stockton,California 952051 a 209 468-3420.1 F 269 464-0138 1 www.sjgEoAv o�d PP END 16-02 07/Otr1025 CamScanner