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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 checclist to the festival coordinator three (3)weeks prior to this eventPU`nw {- ..--- 1. 1.Name of Event: i, � it Dates. 2 The following is information about my organ izationlbusiness: Name of organizationibusiness k_'--(,1 (A S ti',lr •`a +1� r Address: �� _fit Prone r'ol'i ) `l �� `�-fi Alternate (Z1. k 3. List food to be sold or given to the public. t ! - t(: �( � t . 1j . !=rya 1'� `�' � , vtS- 4- j am providing food that is NOT preparea at home: L Yes No All food is prepared on-site or is from approved commercial facilities:'® Yes ❑ No Name of facility x .. v, t"� r'.� 1�i�'r�r' - _- Phone: (L1 i t } -7:)c, _4 ` � Address of facility: 4 7s C! Gt, 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. -i 4-Other(specify) Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers. or prepackaged foods from approved sources B 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) 7. Electricity is provided for my booth's use. R Yes ❑ No B. I am providing an accurate probe thermometer to 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 temperature control for the hot holding of all potentially hazardous foods above 13S'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. 186E E I-la??Iton Avenue I Stockton, C.alirornia 95205 1 'i 209 468-3420 } F 209 464-0133 1 vr;v✓wv.sjcehcl com EHd 16-02 Page 7 of 11 TEMP EVENT APP 0713117