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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1.I.Name of Event: <br />2. <br />Address A • <br />Phone: <br />3. List food to be sold or given to the public <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />fStiH <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />7. <br />8. <br />SAN JOAQUIN <br />COUNTY <br />Name of organization/business Q <br />(^>30) - o 3^-^___________ Alternate: ( <br />) lyu JP/d ( CX <br />Date(s): 'Ij3Q33 <br />1868 E. Hazelton Avenue | Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 I www sjqov orq/ehd <br />n^1,6"02 p"°e 7 0,11 TEMP EVENT APP <br />06/19/19 <br />the festival coordinator three (3) weeks prior to this event. <br />The following is information about my organization/business <br />-jzr UP 1________ <br />f -u. <br />) <br />I am providing food that is NOT prepared at home. NJ Yes No <br />All food is prepared on-site or is from aoproved commercial facilities: Yes No <br />Name of facility: ? ''■O <0 $1 • I h) 0V CO Pk Phone: Address of facility: ^Z>~V4> <br />I am providing a booth with the following, (to protect my unpackaged foot/and food-preparation areas from flies, <br />dust and the public) <br />K) 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 /> Other (specify): A\Sp 0 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br /> Other (specify):__ ____________ <br />Electricity is provided for my booth's use: H Yes No <br />I am providing an accurate probe thermdmejer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Kj Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F. r I <br /> Camp stove Aj I Stemo & hotel trays <br /> Double steamer M Steam table & lids <br /> Electric stove top Other (specify)