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Environmental Health Department <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPa(]C 7 Of 11 <br />7. <br />8. <br />SAN JOAQUIN <br />COUNTY <br />(■t < <>f lift • . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Yes No <br />bmdter to measure the hot and cold holding of potentially hazardous <br />n: KfYes No <br />:iXc control tor the hot holding ot aii potentially hazardous foods above <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwKV.sjcehd.com <br />EHDia.02 Pane 7 Of 11 TEMP EVENT <br />07/3717 <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> On-site hose bib that is connected to a potable water source. <br />[Vother (specify): fell I-f < VyS <br />Electricity is provided for my booth’s use:^[Y <br />I am providing an accurate probe thernlometi <br />foods during all times of booth operation <br />I am providing the following hot temperate— <br />135°F: <br />LI Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />; 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 />All food vendors (both for profit and non-profit) <br />the festival coordinator thraa (3) week^prior to this event. <br />1. Name of Event: VcKL <br />The following is information about my organization/business: <br /> Name of organization/business: (2 _L <br />TtQ Ims s' GV. La <br />( Alternate: ( 2^A ) '' (^OO C^------------ <br />List fond to he sold or given to the public: .Q <br />I am providing food that is NOT prepared at home: □ Yes |^No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: —— Phone: (------1— --------------------------------- <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 /> 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. x- <br />Other (specify): *1 T A11 --------------------------------------- <br />Note: The only operations not required to provide enclosed booths <br />are required to return a signed and completed copy of this checklist to <br />' A i \ / /l^lClfl^T Date(s): OS/