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f- <br />Environmental Health Department <br />DateI.Name of Event:1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Other (specify): <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 be provided in my booth by the following methods: <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wvw.sjcehd.com <br />EHD 16-02 Page 7 of 11 TSU? ZVCf" <br />07/3/17 <br />M-: <br />■ <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: 0 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />0 Sterno & hotel trays <br />0 Steam table & lids <br />0 Other (specify) <br />SANJDAQUIN <br />------COUNTY------- <br />Gr-’otneis grows here. i > y <br />TEMPORARY FOOD VENDOR’S APPLICATION s/zg'Ab <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />hYbj ________ <br />The following is information about my organization/business: v <br />Name of organization/business: 7^- S /•'T <br />Phone: ( J2C> ‘fr ~ && 6 Alternate: ( ) <br />List food to be sold or given to the public: ,■ <br />y ■ rm. <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities:'Q^Yes 0 No <br />Name of facility: J f-r, Phone: C2g>7 ) S--------------- <br />Address of facility: 7 ---------------------------- <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.