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Environmental Health Department <br />t. <br />2. <br />CA , <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meals, tamales, cooked beans, rice, <br />Fags 7 of 11 <br />7. <br />8. <br />Ha2elton Avenue I Stockton, California 952051 T 209 4 68-3420 | F 209 464-0138 | www.sicehd.corn <br />^17 Fags 7 o( 11 TEMP EVENT AFP <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 /> On-site hose bib that is connected to a potable water source. <br />□ Other (specify);A) _______ /• <br />Electricity is provided for my booth’s use; Yes Q'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 Q/No <br />1 am£r£vidIng the fal)owi"9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove sterno & hotel trays <br /> Double steamer Steam table & lids <br />O Electric stove top other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br /> SANJOAOUIN <br />?------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />I.Name of Event Lcd\Date(s): <br />The following is information about my organization/business: <br /> Name of organization/business: I rSg, Dp. I ^Vx <br />Address: ST-I- <br />(^1 ) Z/^7-z/7(^3 Alternate: <br />List food to be sold or given to the public: CzW^vr'Cl-^ Cr^rd^l/t <br />1 am providing food that is NOT prepared at home: Yes S^o <br />All food is prepared on-site cr is from approved commercial facilities: Yes <br />Name of facility; hi ________________________Phone: £ <br />Address of facility:A* /A __________________________________________________ <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 />Q 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. <br />[5/Other (specify):t <br />Io