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Environmental Health Department <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />2, <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />Cos tv <br />9. <br />! <br />’ i <br />I <br />8, <br /> Sterno & hotel trays <br /> Steam table & lids . <br />jQ^ther (specify) Q\KcV(s£)uA Ccw3 <br />meats, tamales, cooked beans, rice, <br />1868 E. Hazelton Avenue | Stockton, California 95206 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />EHD 16-02 Pti[]0 7Df11 IkMIEVr-NIAU <br />C7/3H7 <br />SANJOAQUIN <br />!''' ‘i COUNTY - <br />''’Vn'V Gieatncss grows <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 />I.Nanre of Event:. / i Iftmvs Pv kUr__. ■_2___Cofc(?) <br />The following is infonnation about my hipahlzatlob/bUalheaB: <br />of organlzafionflwoinoss; SO'AYffeH ____________ <br />Address: 6O0 V* iW-v Law?. (X f'TT ..............— <br />TCh Ti V WL____ <br />List food to be sold or given to the public: Scay <br />_______Alternate: ( )_____ ____ <br />N~Aot)jV\ QoCC\.CC\0\ <br />I am providing food that is NOT prepared at home: Yes ^Np <br />All food is preparedon-site or is from aoproved commercial facilities: O Yes No <br /> Na™ of faoffiy: ____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 /> A booth with walls and coiling 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 feed preparation <br />areas from the public. . . <br /> <br />pother (specify): Tvf v(. V L -------------------------------------------------T— <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 bo provided in rny booth by the following methods: <br />0 Approved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br />Other (specify): ’ 'iL. <br />Electricity is provided for my booth’s use: Yes I. J No . <br />1 am providing an accurate probe thermometer to ineasuro the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes [_J No <br />I am provid ng the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135^: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy producte.