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Environmental Health Department i. 2. 3. 4. 5. 6. meats, tamales, cooked beans, rice, Other (specify):----------------------------- -------------------------------------— Note; The only operations not required to provide enclosed boothsNote; The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ^•Approved bottled water. On-site hose bib that is connected to a potable water source. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | v^w.sjcehd com EHD16-G2 PageTcfll IhMWtvtN. arr 07/3/17 \ SANJOAOUIN . ■’ ------COUNTY------- CrcuHirss y:uw5 TEMPORARY FOOD VENDOR’S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed cop^r of this checkbstto the festival coordinator three (3) weeks prior tothis event. <0 ' V’ Date(s): 7. Electricity is provided for my booths use: ves LJ no 8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous " foods during rill times of booth operation: Yes No • ’ • 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above O Sterno & hotel trays Steam table & lids Other (specify) ' il 1. Name of Event: C-AJ The following is information about my organization/business: Name of organization/business: -------------—------------------------ Address: \O TO9VWt iUWU--------------------------------------------------- Phone: Y\-\~f-------------------- Alternate:! )_-------------------------------------- List food to be sold or given to the public: S>U.AV&- T,Y.~£- ------ I am providing food that is NOT prepared at home^ Yes No All food is prepared on-site oris from approved commercial facilitiesjg'Yes No Name of facility: Phone: L-------1-------------------—------------- fam providing'abooth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) k/A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly keening, completely enclosing open food areas, it will also have a smooth d^ab'%fl°or asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify):;________-------------------- Electricity is provided for my booth's use; Yes No “ foods during rill times of booth operation: Yes No • I am j 135°F: Camp stove Double steamer Electric stove top Note: Examples of potentially hazardous food Include; vegetables, potato salad, eggs, and dairy products.