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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Pl//!1 1 Name of Event <br />2 <br />Adotess <br />Phone <br />3 L st food to be sold or g*ven to the public <br />4 <br />5 <br /> Other (specify) <br />Approved water for dnnking utensil and hand washing will be provided in my booth by the following methods6 <br />Approved bottled water <br />I On-s>te hose bib that is connected to a potable water source <br />c <br />9 <br />meats, tamales, cooked beans, rice, <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved d'Sper.sers or prepackaged foods from approved sources <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />COUNTY <br />A booth w th wal s and ceiling constructed of either wood canvas, plastic similar material and fine mesh fly <br />screening completely encios.ng open food areas It will also have a smooth and cleanable floor (concrete <br />aspha t c ean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />a'eas from the publ c <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Dateis) <br />P ^2 ________ <br />__, c h, <br />Alternate ' 222 <br />I am providing food that is NOT prepared at home ££ Yes No <br />Al food is prepared 09-S'te oris,from approved commercial facilities [3 Yes No <br />Name o‘ facility I i < A Phone {QlV) ^3^" <br />Address of facl ty 5^ ^ 7 S Wrh 3 / <br />I am p-ovio ng a booth with the following (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br /> Other (specify) ______________________________________________ <br />Electricity s provided for my booths use ^jYes O No <br />1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />'oods du'rg a I t.mes of booth operation (3 Yes No <br />am provid ng toe following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F <br />, Camp stove <br />' Double steamer <br />Electric stove top <br />A'i food vendors (both for profit and non profit! are requ red to return a s gned and completed copy of ttms cheol st to <br />tne festiva coo-dmator three (3) weeks prior to this event <br />The following is in’ormation about my orgamzation/busmess <br />Name of organizaticn/busmess <br />i?cEE Hazelton Avenue I Stockton California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov org/ehd <br />PageTofll TEMPEVtNIAPP