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E n v ii r o n liin e n ta IIC HI e a II t h D e p a ul m g r n TEMPORARY FOOD VENDOR’S APPLICATION I.Name of Event 1. 2. 3. 4. 5. I I Other (specify): those which sell beverages from 6. On-site hose bib that is connected to a potable water source. 9. meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Sterno & hotel trays Steam table & lids Other (specify) 7. 8. SAN JOAQUIN cot JNTY All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. VAuSlC* Date(s):J 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com 07/3/17 Other (specify)---------------------------------------------------------------------------------------------------------------------------------- Electricity is provided for my booth's use:8'Yes 0 No 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 I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: t^Camp stove Double steamer Electric stove top Note: The only operations not required to provide enclosed booths are approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods' ^/Approved bottled water. The following is information about my organization/business: Name of organization/business: i <3^ |-------------- Address: Phone: ( 2,0,1 -cri TI Alternate: (1(6)22X1- H 7-^ List food to be sold or given to the public: I am providing food that is NOT prepared at home:"F^-Yes Q No All food is prepared on-site or is from approved commercial facilities: [^.Ycs f i No Name of facility:Phone: {-------)--------------------------------------- Address of facility._____________—----- I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ’SLA 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 (conciete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public.