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DaXefsYflUa 29-7)1, 26251. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br /> Other (specify): _____________________________________—— <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />©'Approved bottled water. <br />[tfOn-site hose bib that is connected to a potable water source. <br />. SAN JOAQUIN <br />d------COUNTY------ <br />G r e o t n •- $ > (j r c w s here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Environmental Health Department7 rT\ -< <br /> Other (specify):----------------------------- ------ --------- <br />Electricity is provided for my booth’s use: [Ug Yes I—I No <br />I am providing an accurate probexthermometer to measure <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF: <br />©Camp stove O Sterno & hotel trays <br /> Double steamer Q Steam table & lids <br /> Electric stove top IZOther (specify) < <br />Note: Examples of potentially hazardous food include: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov^rg/ehd^ <br />EHD 16-02 Page 7 of 11 <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: A//Q l-TT "T <br />The following is information about my organization/business: <br />Name of organization/business: A1 Z? A/jTV <br />//-33^ cfl ____________ <br />(2^ ) 8757 Alternate: ( ) 3^ ~ ------- <br />List food to be sold or given to the public:, <2,hich>Ai< kakn b & i <br />I am providing food that is NOT prepared at home: IZfYes No <br />All food is prepared on-site or is from approved commercial facilities: E'Ves No <br />Name of facility: (/}LA M Phone: (^^) ------- <br />Address of facility: f)(J 5* /7- — <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 />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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.