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Environmental Health Department <br />I.Name of Event:1. <br />2. <br />Phone: <br />'y3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />8. <br />SAN JOAQUIN <br />-----COUNT Y------ <br />Greoln-.-sr. y.-r/.s he,.. <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 />EHD 16-02 Page 7 of 11 TEMP EVENT <br />07/3/17 <br /> On-site hose bib that is connected to a potable water source. <br />brother (specify): Cd J-P <br />Electricity is provided for my booth's use: <br />I am providing an accurate probe therrrf <br />foods during all times of booth operation: <br />I am providing the foilowing hot temperatuf <br />135°F: <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br /> 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 />Other (specify): rtvUspd 'trailed'_____________________ <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 />The following is information about my organization/business: <br />Name of organization/business: <br />Address: <br />( " <7 £0*1____________ Alternate: ( 2-0*1 ) "S'6 OO £=■ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes £Xd\'o <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility:Phone: {)--------------------------- <br />Address of facility:_ __________________________________ <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 />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) week^-prior to this event, a , t . i. .fa PUUV DateM: Qs/ofo/zyVW <br />WVes n~No <br />fom^tgr to measure the hot and cold holding of potentially hazardous <br />Yes No <br />bntrol for the hot holaing of aii poteniiaily hazardous roods above