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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br /> Approved bottled water. <br />135OF: <br />O Camp stove <br />Q Double steamer <br /> Electric stove top <br />_______ _ Alternate: ( <br />Allti <br />meats, tamales, cooked beans, rice, <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved waterfor drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />umh J vr» wv ’ •’ <br />*—COUNTY---- <br />the festival coordinator three (3) weeks prior to this event. <br />1868 E. Hazelton Avenue I Stockton. California 952051 T 209 468-34201 F 209464-0138 | www.sjgoy.oi^ehd <br />EHD1M2 Paso 7 of 11 TEMP EVENT APP <br />03? 2W2023 <br />/ <br />7. <br />8. <br />r* <br />The following ts information about my organization/business: <br />HeavPnh ice <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: <br /> Name of facility: ___________a n s. /» ------------------ <br />Address of facility: 0/U z / f <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 />IvTa booth with walls and ceiling constructed of either wood, canvas, plastic, similar materia! 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 /> On-site hose bib that is connected to a potable water source. <br />□ Other (specify): __uck th- A -------------------------- <br />Electricity is provided for my'booth’s use: LI Yes LJ No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during an 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 />Q Steam table & lids <br /> Other (specify) <br />(^YesLJNo <br />Phone: (1 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> Date(s): 4/27- ^23/2^ <br />Name of organization/business:_ <br />J C aprirmm --------- <br />(joi) ___ Alternate: ( <br />List food to be sold or given to the public: