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REC-008 <br />Environmental Health Department <br />i. <br />* <br />Address <br />209-818-3100Phone: <br />List food to be sold or given to the public3. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods.6. <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 />Name of organizationbusiness: <br />1821 Chesapeake Ave. <br />I am providing food that is NOT prepared at home Es/fes No <br />All food is prepared on-site or is from approved commercial facilities: Yes QiMo <br />Name of facility:Phone: <br />Address of facibty: <br />I am providing a booth with tire following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />The following is information about my organizatiorVbusmess: <br />Main squeeze lemonade <br />EiyA booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal and line mesh fly <br />screening, completely enclosing open 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 food 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 /> Sterno & hotel trays <br /> Steam table & Ids <br /> Other (specify) <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sigov.org.'ehd <br />EK) 16 02 Pago 7 oill TEMP EVENT APP <br />061919 <br />SAN JOAQUIN <br />------COUNTY------- <br />Greotnen gr0Ml he,f. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): __________________________________________________ <br />Electricity is provided for my booth's use: Yes Q44o <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during al times of booth operation: [^Yes No <br />I am providing the following hot temperature control tor the hot holding of all potentially hazardous foods above <br />135OF: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />* <br />Alternate: <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 />, ,Community creep in . , , Sept 7,20251 .Name of Event:, H Date(s):