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1:02 AM Scan_20230328.jpg <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: 1. <br />The folbwing Is Information about my organization/buslness:2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />Bother (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:S. <br />to measure the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPPn()» 7 Of 11 <br />ife.co rn/mail/u/O///inbox/FMfcgzGxRnVllvmNBxVdTzttgfpwjBbc?projector=1&rn0SsagePartld=O.1 <br />CamScanner <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />3. <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. s <br />SAN JOAQUIN <br />- COUNTS <br />Date(s): <br />D^pproved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />I860 E. Hazelton Avenue | Stockton, CoilforniH 05205 | T 209 400-3420 | F 209 404-0138 | www si9^-°r,^®'^l <br />E HO 1 &-O2 PnO. 7 of 11 TEMP EVfcNT A‘ <br />06/19/16 <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) aro required to return a signed and completed copy of Ibis checklist to <br />ths festival coordinator three (3) wenks prior to this event. <br /> Other (specify);_________________ __ _—-------------------------------- <br />Electricity is provided for my booth’s use:^ Yes No <br />I am providing an accurate probe thermomet^P to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135‘F; <br /> C^mp stove <br />0 Double steamer <br /> Electric stove top <br />Name of organization/business: ‘ < <br /> (^7 Alternate^ } ------- ,---------------------f <br />List food to be sold or given to the public: //) ST ■ <br />1 am providing food that is NOT prepared at home: gZYes No > <br />All food is prepared orvsjie-or is from aoproypd commerci^Macilities: [Fl Yes NoName of facility: C <^' <br />Address of facility: C./c, C <br />I am providing a booftY^nth the following: (to prrit^ct my unpackaged food and food-preparation areas from flies, <br />dust and the public)