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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event Datefs):1. <br />2. <br />Address: <br />Phone <br />3. <br />4. <br />5. <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing often 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 toot! preparation <br />areas from 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 /> Sienro & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1860 L. Hazelion Avenue I Stockton. California '15205 | T 209 4fl8-3420 | F 209 484-0138 j www.sfgov.orgfehtl <br />EHO Pww Im II mw»EVENT AW> <br />oshwie <br />7. <br />8. <br />SAN JOAQUIN <br />C OU NTV <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during ail times of booth operation Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F <br /> Camp stove <br />[j Double steamer <br />O Electee stove top <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 /> Other (specify)._ ______ ____ _____ _ __________ __ <br />Electricity is provided for my booth’s use: Q Yee^jNo <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />> or is from approved cpmmercial facilities. Yos No <br />7 i f £chttAkivy 66CPhpne: ( ) X IQ <br />. ______ _ . ? z?X pc C <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 />The following is information about my organmation/business: <br />Name of organizatfon/business: I ( <br />-zoio Cofl'ee ItJ (■'-<-! CH <br />nc/ll ‘Ki?6/_____ ____ Alternate: (“2^ ) ~2 ?4 ‘T _________ <br />List food to be sold or given to the public pff C j pl? S / f’S <br />I am providing food that is NOT prepared at home ’ll Yes O No <br />All food is prepared on-srte or is from approved " <br />Name of facility f ----------- - , — , <br />Address of facility: (> Co-ff&e