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I.Name of Event1. <br />Phone: <br />-3. <br />4. <br />1 <br />5. <br />I ' <br />6. <br />meats, tamales, cooked beans, rice, <br />Q Other (specify): <br />Note: The only operations not required to provide enclosed booths <br />1 . - <br />)^s0No <br />'hone: (___ <br />|\UNo <br />tomeasure <br />Yes No <br /> Alternate: ( ^2 <br />UMI1->yUrtWVHl ................................... <br />—COUNTY------ <br />‘GrgGLncss graivs here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />and cal ling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />open food areas. It will also have a smooth and cleanable floor (concrete, <br />iJ'sjripbth wood are acceptable) and constructed to separate food and food preparation <br />7. <br />8. <br />9** <br /> Other (specify):_ <br />Electricity is provided for my booth’s use: Yes <br />I am providing an accurate probe thermometer tomeasure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: BJ Yes No <br />I am providing the following hot temperaturecbntrol for the hot holding of all potentially hazardous foods above <br />135°F: , <br />|~] Camp stove O Stemo & hotel trays I ■ <br />0 Double steamer 0 Steam table & lids <br />0 Electric stove top O Other (specify) <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 | wvm.sjgovo^eh^ <br />EHD 16-02 Page7of11 <br />06/29/2023 <br />All food veiftfefe (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival cbftrdinator three (3) weeks prior to this event. <br />RIVER iSlAmas CJFM_________________Date(s): ^[zi- <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: <br />____ <br />List food to be s^0 or^Yen t0 the : J <br />I am providing food that NOT prepared at homeit^es 0 No , <br />All food is prepared on-site or is from approved commercial facilities: [ <br />Name of facility: <br />Address of facility: ------- <br />I am providing a booth witivfhe following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />A booth with walls au <br />screening, completely ei <br />asphalt, clean tarps anttj <br />areas from the public. < |