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Environmental Health Department <br /> <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />. SANJOAOUIN <br />'■ ------COUNTY------ <br />‘ ‘h <br />■ 1 .. t <br />7. <br />8. I am <br />! SkTfolfo^nS hoi'tem^S^con^otfor the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br />S^iher (specify) <br />.L:2!!y ■ Hazardous food include; <br />!ge&es, potato dairy products. <br />,868 E. Hazelton Avenue | Stockton^i^feh 209 468-3420 | F 209 464-0138 | —.sjcehdxom <br /> ___ <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):_________________ _____—---------T--------------—------------------------------------------------- <br />Electricity is provided for my booth's use: Yes No r . u <br />1 «,;> providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />■ foods during allies of Mhh„f h„M„n rfa„ nntf.n„allu bazardous foods <br />135°F:' <br /> Camp stave <br /> Double steamer <br /> Electric stove top <br />Note: aarnpjes of pcto::felly ^ard <br />Grt’cri rievi grows fu?rc. <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 />1. Name of Event:. _ Date(s): ! <br />The following is information about my organization/business: s ' <br />Name of organization/business: <br />ZVe _____-______ <br />Phone: ( ' Alternate: ( )-------------—----------------------- <br />List food to be sold or given to the public:^xIS<//?S Jl) S 60 I' - . <br />I am providing food that is NOT prepared at home: 0 Yes <br />All food is prepared on-site or is from approved commercial facilities: ©Yes No <br /> Name of facility: Phone. (------1_----------------------------- <br />I am providing a^ooth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />R<bccth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />Sreeriing, 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 /> Other (specify): , ■------------------------- ----------------------- <br />Note: The only operations not required to provide enclosed booths <br />meats, tamales, cooked beans, rice,