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■ 'I,-..Envkonmienta^ HeaHth Department <br /><- <br />I.Name of Event:1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />5. <br />pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />iM’ <br />JpJ Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <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 />\ SAN,JOAQUIN <br />------COUNTY------- <br />Great r.c>s yiCv.s <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EH D 16-02 Page 7 of 11 TEMP EVENT <br />D7/S M 7 <br /> Other (specify):------------------------------------------------------------------------------------------ <br />Electricity is provided for my booth’s use: H Yes 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: ® Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />••■■■ f: <br />ii -..‘. A" <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 /> UdA Datefs): 1^5^ <br />The following is information about my organization/business: 't 1 <br />Name of organization/business: <br />Attpi S2Z- Alternate: ^Ibh 60^^^ <br /> List food to be sold or given to the public: | tT'.p.ZX’ <br />I am providing food that is NOT prepared at home: p^Yes Ll No ' <br />All food is prepared on-site or iq from approved commercial facilities: X! Yes No . - <br />Name of facility: _______________Phone: V ) <br />Address of facility:\ (5^) 1^) ------------------------------------------ <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.