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U-j? -L 1 LVLL 1U. 11 iV JViJLVVL II IL UI IUI\L I NI.AL VJ <br /> ti <br /> Ilnj <br /> SA +J 0 A 0 u I N Environmental wealth Department <br /> —C Q U N T Y.. <br /> £7J'(?Ct(JIPti& grows heIr. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for pruriit and non-proflt) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this avant. <br /> 1. 1.Nerne of Event: u bates 1 <br /> 2, The following Is information about my organlzation/business; <br /> Name of organizatiorifti8ine8s: - '(Yt C 09"j�) - <br /> Address: 1' - t IL/10lJlf C1, <br /> Phone: (a p q Alternate: ( ) <br /> 3. List food to be sold or given to tha public: 1S' Q lllf'C l(k, Tr i -�ip J IP 05 <br /> 4, 1 am providing food that is l 0 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:L. <br /> Address of faclgty: <br /> 6, 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> A booth with walls and celling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> oreening, complotoly enciosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptablo)and constructed to separate food and food preparation <br /> areas from the public. <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 /> 6. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> Approved boated water. <br /> []On-site hose bib that is connected to a potable water source, <br /> II Other(specify): <br /> 7. Electricity is provided for my booth's use: Yes W No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: es❑No <br /> 9. 1 am providing the following hot temperatur&b6ntrol for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> d camp stove ❑ Sterno&hotel trays <br /> C]Double steamer y Steam table&llds <br /> ❑ Etectfic stove top d Other(specify) <br /> Note: Examples. of potentially hazardous food Includa: meats, tamales, Cooked boans, rice, <br /> vegetables, potato salad,eggs, and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 E F 209 454-0138 1 www.9jgov.org1ehd <br /> EHO 16-02 Pnga7 or 11 TEMP EVENT APP <br /> 09119/19 <br />