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Environmental Health DepartmentSAN JOAQUIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Marne of Event:1. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />P^Yes □ No <br />Phone: 1 <br />186a E. Hazelton Avenue J Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | <br />CH01M7 PaqcroMI <br />The following is infcrmaton about my crganization/business: <br />fl£EO MQglLg PfZZA- _________ <br />FtW t/AZ. oate(s): <br />Ail food vendors (both for profit and non-profit} arc required to return a signed and completed copy of this checkfist to <br />the festival coordinator three (3) weeks prior io ths event. <br />41 ~f A NN I j At Date(s): U)lt ' / t/7 <br />Name of orgarkzatjortfbusiness: <br />102^/7 <br /> <br />(Z.0^ } Alternate^ ) <br /> <br />IM food to be sold or given to the pubte: —F( ^-£1^----------- <br />I am providing food that is NOT prepared at home: 7] Yes (£1 No <br />Ail food *s prepared on-site or s from approved commercial faqjftres <br /> <br /> Address of tartldy: ZVfi S ---------------------------------------------'Z----------- <br />I am provKlmg a booth with the following: (to protect my unpackaged food and food-preparaton areas from hies, <br />dust and the pubbe) <br />Pl A booth with walls and ceiling constructed of either wood, canvas, pfastic. similar material aixi fine mesh fly <br />' screerunq completely endosing open food areas. It wiH also have a smooth and cteanable door (concrete, <br />asphalt dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br /> two? iNfO <br />Note: The only operations not required to provide enclosed booths arc those 'which sefi beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing wfll be provided in my booth by the following methods: <br />[ji^Approved bottfod water. <br /> On-site hose bib that is connected to a potable water source. <br /> <br />Other (specify): <br />Electricity is provided for my booth's use: Yes-J No <br />I am providing an accurate probe thermoro^er to measure the hot and cold holding of potentially hazardou-. <br />foods during aB times at booth operation:^ Yes No <br />i am provdkig the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135*F’ ——, <br />| | Camp stove } [stemo & hotrrf trays <br />Q Double steamer O Steam table A lids <br />["] Electric Stove top O Other (specify ) <br />Note: Examples potentially hazardous food include: