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gtopeq8ZM>ZWZ9t=l‘AJ!S,»St<>peq8ZfrPZM29k=M)x‘“nqu!=ipjees^)d=M0!A’8U0-6^OdnAJVN9O=J9ASf^8Ot*:c^9!P=iireZ=!ni/O/n/l!euj/ujooe|6oo6|!BUJ//:s<iuM <br />5 <7w <br />■\? *iC /ervfi <br />5. <br />Average Age Total AHencence <br />3 Yes <br /> Yee <br />___Number ol dumpsters, 'i <br />APPLICATION <br />2. <br />/<•/tn.DateEven: Coonhnalor <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR S APPLICATION <br />CA I Address <br />Prone <br />List food to be sold or green to Ute pubic <br />5. <br />3>poroved bottled water <br />n Orv vie hose bib that is connected to a potable water source <br />the hot and cold holding ol potentially hazardous <br />meats, tamale*, coolied beans, rice, <br />(pelqns ou) - iiewg ei-oz/es/fr <br />ItMal <br />2 <br />3 <br />5. <br />n■ w:~) G/i ~ <br />135T <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />-COUNTv <br />,y>rlC‘ ■ <br />AH food vendors (both tor profit and non-profit) an required to return a signed and completed copy ol this checklist to <br />the festival coordinator three (3) week* poor to tt» event <br />\f ol|La) At^frucy^ (st yii ' 'y.!0 <br />I am providing food that B prepared at home □YesLJN'- <br />Alt food is prepared on-slte or Is from approved commercial facilities El Yes No <br />Mama of facility («uL y,t ,/<. Phone I A, -Z.) j1, <br />Address of facaty 'III N Pa_________________ _________________ <br />I am prowong a booth with the toSowmg (Io protect my unpacAaged food and tood-preparafion <br />dust and the pubhc i <br /> , Time of Event. <br />■ z'l /^Zx/a-i'' <br />Detets) <br />GENERAL EVENT FILE INFQRMA <br />Name of Event ,'KVscm-tA <br />Datefs) of Event ___ <br />Location <br />Event Coordinator (Name) / z <br />Mailing Address <br />Number ol Food Booths ____-Z. <br />Approsimate attendance at peak time <br />Gfito <br /> Yes <br />QjNc <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy product*. <br />UTILITIES <br />Is potable water suppMd and available for each food vendor <br />Is eiectncity supplied and available tor each food vendor <br />Are janitorial facilities available <br />Number of todets provided : <br />Name of sanitary garbage disposal company. <br />Method of disposal of bquid waste for food booth* c-c <br />J <br />Teiepnono )tv; <br />186a E Hazelton Avenue I Stockton CaWorma 95206 T 209 468-34201 F 209 4640136 ! *** <br />two i*« ‘•wv ’ u ’t fi'0"’ <br />obytr <br />Submit the following to the Environmental Health Department two week* poor to the ever" <br />al Temporary Event Application <br />b) Application Review F ee of $ 152 <br />C) Temporary Food Vendors Applications tor each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />If the event « selected tor mspecuon the Event Coordinator will be tx»ed for nspection '•me <br />* $152 per hour (weekdays 8 00 am to 5 00 pm) <br />* Arter regular business hours (weekday weekends and holiday*) the mspecuon is charged at the <br />noudy rate, calculated at one and one haff lime* ($228 per hour) <br />Thia application ia to ba compfatod and olgnad by the Event Coordinator, than roturnad to tha <br />Environmantid Haatth Dopartmont artth all Food Vendor * Appllcationa gg /gttr 0«ff MV tffrtE <br />^understand that as a temporary event coordinator I am responsible for mealing California State <br />standards and the Environmental Health Department policies and procedures <br />/ iuLx C V-ec-.Zc -------- -------— <br />Zi-X :--r77G/ltr . T fA ,s <br />areas from Ikes <br />•M"^ <br />1868 E Hazollor. Avenue | Stockton California 95/M, T, 209 468-3420 j F 209 464-0138 I www sjeend^m <br />QWtT <br />(2crt > <br />Name of organizatiorVbuune** J__ <br />Sc-5 \Z«.; <br />___________ Arternate ( 2c*S > - ? T > <br />■ i>V.T VLv.A/tKalowvy <br />H.A booth with wans and ceiling constructed of either wood, canvas, plastic similar material and fine mesh fly <br />screening completely enclosing open food areas It will also have a smooth and cleanable floor (concrete <br />asphalt dean tarps and smooth wood are acceptable! and constructed to separate food and food preparation <br />areas from the public <br /> Otherwteofy) P^< ----------------------------------------------------- <br />Note: The only operations nek required to provide enclosed booths are those which SHU beveraqes from <br />approved dispensers or prepackaged foods from approved sources <br />Approved water for dnnkmg. utensil and hand washing wit be provided n my booth by the following methods <br />1 1 Nwn. of Event (_ XCVMHr CK y <br />2 The Wtowng B tntormabon about my orgamzabori business <br />T**-z <br /> Other (specify):_ ____ ______ <br />Eiectncity is provided for my booth's use Yes EJ No <br />I am providing an accurate prob* thermometer Io measure <br />foods dunng all time* of booth operaticri: Yes JU No <br />I mi provxkng the loOowing hot temperature control for the hot holdmq <4 an potentially hazardous foods above <br /> Sterno 8 hotel Bays <br /> Steam table 6 Ws <br /> Other (specityl