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Environmental Health Department <br />I.Name of Event: Date(s): <br />2. <br />Address: <br />Phone;() Alternate: () <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />The following is information about my organization/business: <br />Name of organization/business: <br />SAN JOAQUIN <br />------COUNTY-------- <br />■ ''ent? Qfoivs rrt’rfi’. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />z eTnr,o re,urn a si9ned and c°mpteted <br />1. <br />Haze,ton Avenue I stockton, California 95205 I T 209 468-3420) F 209 464-0138 | www.sicehd com <br />OZ/Si6 PageZoflt TEMP EVENT APP <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: Yes No <br />Name of facility; phone; ( } <br />Address of facility:,__________ <br />1 ^sTand thA nnhiM f°"°win9: (t0 protect ^packaged food and food-preparation areas from flies, <br />UUdl al IU Ulc pUDIICJ <br />Tr "1S and ,Cei'ing const™cted of either w°od' canvas, plastic, similar material and fine mesh fly <br />9i compfetely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />aXts from the pubHcand Sm0° h W°°d are acceptable) and constructed to separate food and food preparation <br /> Other (specify): <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 /> Other (specify):____________ <br />Electricity is provided for my booth’s use: Yes No -------------------------------— <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />1 Pr°viding the following h°t temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.