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'° x. S A N J 0 A Q U I N Environmental Health Department rjT COU `TY Greotness grows here_ TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event- 1. 1.Name of Event: Date(s): ,,,n_,ara 2. The following is information about my organization/business: Name of organizationfbusiness_ Cwising Cones 7 Address: 2668 Coolidge Pi. Manteca CA A53.37 Phone: ( 209 ) 2R43495 Altemate:( 209 ) 222e e 3. List food to be sold or given to the public: Snft.^;PrvP ice Cream 4. 1 am providing food that is NOT prepared at home: ❑Yes❑ No All food is prepared on-site or is from approved commercial facilities:❑ Yes❑ No Name of facility: owp-rrss nistritu,rK,n Phone: ( x,a ) au_xnn Address of facility: US K11my Rd Tialrnk CA 95380 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, dust and the public) $'A booth with walls 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. / Other(specify): f M ! mod/Al / G 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): Onboard water tank 7. lectricity is provided for my booth's use: ❑Yes o 8. 1 am providing an accurate probe thermomr t measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes❑ No 9_ 1 am providing the following hot temperatur control for the hot holding of all potentially hazardous foods above 135°F: ❑Camp stove ❑Sterno&hotel trays ❑ Double steamer ❑Steam table&lids ❑ Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products. 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 k F 209 464-0138 j www_sjgov_orglehd EHO 16-02 Page 7 of 1 i TEMP EVEW APP 06/19119