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f Eiwimrsmental Health Departmerst TEMPORARY FOOD VENDOR’S APPLICATION I.Name of Event: 1. 2. Address: Phone: List food to be sold or given to the public: 3. 4. 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. 0 Approved bottled water. lx) On-site hose bib that is connected to a potable water source. i? 9. meats, tamales, cooked beans, rice, Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids Other (specify) ’fa’.-. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP 00/19/19 . ■ ra 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. 7. 8. I am providing food that is NOT prepared at home: ® Yes No All food is prepared on-site or is from approved commercial facilities: Qf Yes No Phone: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Date(s): Name of facility: Address of facility: SAN JOAOUIN ......CO JNTY -- Other (specify):______________________________ Electricity Is provided for my booth’s use: Yes 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: ® Camp stove ® Double steamer Electric stove top The following is Information about my organlzatlon/business: Name of organlzatlon/business: (<^/) 72. 7" Alternate: (^Z>7) ^83-^