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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />SfocYToAddress: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9 <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPPage 7 of 11 <br />u EKEH <br />7. <br />8 <br /> Stemo & hotel trays <br />J^^team table & lids <br /> Other (specify) <br /> <br />SAIWOAOUIN <br />C O U N I Y <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Hazelton Avenue I Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov org/ehd <br />EHD1&-02 Page 7 of 11 TE.V.? " A! <br />06/19/19 <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 />^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 /> 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 temperaturecbntrol for the hot holding of all potentially hazardous foods above <br />135OF: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: "Sahntv'Ct- <br />£5-5- G Alp.^c Avti S-focY-torr, CA <br />(2-03 ) 6^ -5~2^O Alternate: (2<X ) ^70- 0^9^ <br />List food to be sold or given to the public. dcjSi C/qipS z t <br />I am providing food that is NOT prepared at hon^^Yes No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No LJ H S 1 rC- <br />Name of facility:Phone: ( ) <br />Address of facility:_ <br />1 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 kjkvlc Qivl BecrfaJ Date(s). March