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Environmental Health Department.? <br />i. <br />2. <br />J—c> <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />JZTApproved bottled water. <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SANJOAQUIN <br />------COUNTY------- <br />G^eotness ^ro.vs Y?-e. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www siqov orq/ehd <br />Page 7 of 11 TEMP EVENT APR <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 />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />Date(s): 3^ <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):_______________________________________________________ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: IZfYes No <br />1 Por°viding the following hot temperatufecontrol for the hot holding of all potentially hazardous foods above <br />'JTfstemo & hotel trays <br /> Steam table & lids <br />J2fOther (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Name of organization/business: rlAMRGT-GiAIO <br /><^3o RutLfcD&g bfcsviS <br />(^c^) 5s io Alternate: ( )________ <br />CVxi'<-k-exu / ci-^en <br />List food to be sold or given to the public: ; beike rr^ndr^e^ sigewn <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: <br />Name of facility: ______________________________________ <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 />0 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 />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event:. JI O P X /ZS <br />3 Yes No <br />Phone: ()