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TEMPORARY FOOD VENDOR’S APPLICATION <br />6-v (Xi.I.Name of Event: <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />6 <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />SM4 JOAQUIlF <br />county <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 f A _______Date(s): ‘S | /<-/’ C f / / 6 <br />2 P O- <br />C (A- <br />—u <br />Environmentaffiealth Department <br />Qla. <br />the festival coordinator three (3) weeks prior to this event <br />sl o c k ' <br />Alternate: ( ) <br />Note: The only operabons not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | <br />r*---*» -< « « <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): /_— --------------------- . <br />Electricity is provided for my booth’s use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all fimes of booth operabon: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potenfially hazardous foods above <br />135°F: <br />Q Camp stove <br />Fl Double steamer <br />0 Electric stove top <br />I am providing food that is NOT prepared at home. Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: Q-Yes 0 No <br />Name of facility: ‘S Phone: /tp U 0 f 3a------------------------------------- <br />Address of facility: 3S03 S f <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />duXt and the public) <br />0 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 dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Si'( I m f 'v ________________ <br />D<x>-x - S-t/ Az <br />Name of organization/business: _ <br />—---Guh.