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SAN JOAQUIN <br /> �-c o U N r Y—_. Enviro <br /> nmental Health p <br /> TEMPORARY FOOD Department <br /> All food vendors VEND <br /> the festival co (both for profit and non_ OR 3 APP�lCAT1ON <br /> ordinator three(3)weeks pr°fit <br /> are required to return a <br /> Nam of Event: signed and completed <br /> 2. Lodr Stl eE �� copy of this checklist to <br /> the followin <br /> g is information about <br /> Name of or my°rganization/business: Date(s)_ October-ZU <br /> ganization/business: <br /> Address: sOUr,dou h q <br /> Phone: ( 1 0004 AvOCad � <br /> 3. List food ) 916 230' 0 <br /> to be sold or ���T, � Alternate: <br /> given to the public: } <br /> 4. l am providing food that is NOt S ! ' <br /> All food is �Prepared at ho O U r O U h B„ <br /> prepared on-site or is from a me:Q YeSV77 d <br /> Name of facility pproved corn No <br /> Address rnercial facilities: Yes <br /> 5 ss of facility: No <br /> !am Providing a booth with the folio <br /> dust and the Phone: <br /> Public) wing:0o protect <br /> ❑A booth my unpackaged food and food- re <br /> screeningwith walls and ceilin A paration <br /> asphalt, ' Co completely enclosing open tfo clad wood areas from flies clean of either <br /> areas from the tarps and smooth °d areas. s canvas plastic, si Public. wood are acceptabtet will also have a sm° mifar material and fine <br /> ❑Other ) and constructed-Smooth and cleanable mesh fly <br /> (spec): to separate food ar floor (concrete, <br /> n 1,/� d food preparation <br /> Note: The only operations not required r V ELT <br /> aPPr°ved dispreaf to <br /> 6 Approved ' or Prepackagedpo ide enclosed booths <br /> Water for d ' foods from a are those <br /> nuking, utensil and h approve sources. which sell bever <br /> ❑Approved and washin ages from <br /> bottled wafer. 9 will be Provided in my booth by the following methods: <br /> ❑On-site hose bib that is connected to a potable Water s <br /> 7. ❑Other(specify): <br /> Electricity ource. <br /> 8 l a ty is provided for <br /> 9, m srdurin9 al!fim cu Probe ing an b0l thasrn Yes No <br /> food rate <br /> !ant Providinges of booth o meter to measure the <br /> 735°F- the f°"lowin Aeration.,Q'(el NO hot and <br /> 9 hot temperature cold holding of Camp stove contr r the hot potentially hazardous <br /> ❑Double holding of all Potentially hazardous <br /> foods above <br /> Electric stove top El Steam table <br /> $lids <br /> Note: Examples ❑Other(specify) <br /> eg abl s,Pota otsaladtiallY hazardous food <br /> eggs,g include: <br /> '868 E. Haze lron Avenue <br /> and dairy products. meats, tamales <br /> No 76.02 enue cooked beans <br /> •rvt7 J Stockton California 95 � rice, <br /> 2Q5 I T 209 468-3420 J F 209 464-0738 J <br /> Pao°7 al 71 <br /> www.sjcehd.com <br /> 7EMP EVENT pPP <br />