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Date(s):/?^^ H-TlL 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 />E£K5n-site hose bib that is connected to a potable water source. <br />SANJOAOUIN <br />------COUNTY------ <br />G'-eoin-55 grows N-.-p <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Environmental Health Department <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//5/7/ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov^g/ehd^ <br />EHD 16-02 Page 7 of 11 <br /> Other (specify): _______ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all 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 EH Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top D Other (specify) <br />Note: Examples of potentially hazardous food include:meats, tamales, cooked beans, rice, <br />The following is information about my organization/business: <br />Name of organization/business: A/C 6 6! Pl". <br />, CH ^521/6_______ ________ <br />(2^ ) g'/ST Alternate: ( - 7^33 <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: j/fYes No <br />All food is prepared on-site or is from apjyoved commercial facilities: E^Yes No <br />Name of facility: /?\T /_______zy /—/—f’hor'e: A—78C ~ — <br />Address of facility:. i 5 ------------------- <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 />[p^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 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.