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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5 <br />6 <br />9. <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 />7. <br />8. <br />SAN JOAQUIN <br />COUN TY <br />1868 E. Hazelton Avenue) Stockton, California 952051 T 209 468-3420) F 209 464-0138 | wwwsjgov.org/ehd <br />EHD 16-02 P*(je7cf11 TEMP EVENT ARP <br />0W1W19 <br />1^"F: <br />Scamp stove <br />O Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />.Datejs) <br />t ___________ <br />Alternate: <br />Approved water for drinking, utensil and hand washing wit! be provided in my booth by the following methods: <br />ETApproved bottled water. <br />H'&n-site hose bib that is connected to a potable water source. <br />E?f3ther (specify): ______ _ <br />Electricity is provided for my booth's use: Yes i 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: Q Yes No <br />I am providing the following hot temperature control for the hot holding of aH potentially hazardous foods above <br />^fStemo & hotel trays <br />0 Steam table & lids <br />0*6ther (specify) <5^2-5 C, <br />meats, tamales, cooked beans, rice, <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: L--- 7 /V <br />The following is information about my organization/business: <br />Name of organization/business: <br />I am providing food that is NOT prepared at home: E^Ves No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: f CJjHsXs. Phone: (2^5 ^ <br />Address of facility ■$. ^-S <br />I am providing a booth with ffie following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />S^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 cleanabie 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 />Sather (specify): __________ __________ __ <br />Address: J <br />List food to be sold or given to the public.