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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Datefs):1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464 -0138 j www.sjgov.ofg/etid <br />EHD1&O2 Page 7 of 11 TEMP EVENT APP <br />MHO/IQ <br /> A booth with walls 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Stemo & hotel trays <br /> Steam table & lids <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 />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <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 />I am providing the following hot temperature control for the hot holding of aU potentially hazardous foods above <br />135T: <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: Yes STtfo <br />AU food is prepared on-site or is from approved commercial facilities: 0Y^ □ No <br />Name of facility. Phone: (2^^) <br />Address of fadlitv. O QT • LCf t <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />1 .Name of Event: /ZkI CfrX ^AaCt^IO Date(8): lI <br />The following is information about my organization/business: <br />Name of organlzation/business: I ~€ S A S <br />sveAci cT- toi <br />( f Alternate: ( ) <br />List food to be sold or given to the public: AAccrXcncwS