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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. <br />2. <br />s-Address: <br />Phone: <br />3.L 1 <br />4. <br />L3 <br />5. <br />6. <br />8. <br />9. <br />Page 7 of 11 TEMP EVENT APP <br />SAN JOAQUIN <br />C O U N T V <br />meats, tamales, cooked beans, rice, <br />providing food that is NOT prepared at home: ^Yes El No <br />roial facilities: EXfes No <br /><-~jfihone: (__ <br />fCi/nedi O <br />Camrw^G-r^ ■ <br />G S- S°t('fr'cx/vic yi <br />cun Ha26lt0n Avenue | Stockton, California 95205 | T 200 468-3420 J F 209 464-0138 I www.sigov.org/ehd <br />LHD 16-02 paqe 7 Qf 11 r-»Tr-k.-r .i <br />06/19/19 ----- ... <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />I are acceptable) and constructed to separate food and food preparation <br />C] A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />T------------- ■ ..... <br />asphalt, clean tarps and smooth wood <br />areas from the public. <br />Other (specify): <br />JSTVes No <br />e control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br />^Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Jrr/\ k 3 <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 />Smother (specify): CQtvt I <br />Electricity is provided for my booth’s use: Yes tl 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: ' <br />I am providing the following hot temperati <br />135°F: <br />0 Camp stove <br />EJ Double steamer <br /> Electric stove top <br />I am <br />All food is prepared on-site or is from approved commeryjal facilities: <br />Name of facility: J <br />Address of facility: G <br />I am providing a booth with the following; (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <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 />the festival coordinator three (3) weeks prior to this event. <br />1 Name of Event^r'A^ Date(s): J <br />The following is information about my organization/business: <br />Name of organization/business: c—CM <br />tons S- (C^covcee IgrtC <br />h Z 38 1 <br />List food to be sold or given to the public: r >