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Environmental Health Department( <br />f, <br />1. <br />2'. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats-, tamales, dooked beans, rice, <br /> Sterno & hotel trays <br />Steam table & lids <br />O Other (specify) <br />7. <br />S. <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 [ F 209 464-0138 | www.sjpehd.CQm <br />gUD 16.02 PageTofll TEMPEVENTAPP <br />C7/S/17 <br />All food vendors (both for profit and riofyprdfit).aije required-ta return a signed and completed dopy of this.checklist to <br />the festival, coordinator three (3) Weeks- prior to .this- event. <br />1.Name of-Eva* lOdt " Dat^j: <br />ivuw i.5 -Aiui ^5^ <br />The following is ihfojmation about my organfeafion/business: ' J <br />Na’rne of orgariization/b usiness: ./~7. -----■.—■.— --------------------------- <br />Address: <br />• f^b?) ^3/ - 7/>7 3_______ Alternate Zgfr?) V7/i -i-10L ?____ <br />List food to be sold or given to the public:'. <br />I aril providing food that is NOT prepared at hcme:^/Yes □ No <br />All food is prepared omsite of is from approved commercial facilities: GdYes No <br />Name of facility: Phone; /____i <br />Address of.facility-: __________________________________— <br />____ <br />f <br />I arri providing a booth with the-following: (to protect my unpackaged food arid food-preparation areas from flies, <br />dust and the public) <br /> A booth with walls and ceiling constructed, of either wood, cahVas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and oleanable floor (concrete, <br />asphalt, clean tatps and smooth' wood are acceptable)- and constructed to separate food and- food preparation <br />areas from the public. <br />Other (specify): 7^7)^. _ _ <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 wafer for drinking-, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Oh-sife hose bib. that is. connected to a potable, water source. <br />Other (specify): //D/^, ---------------------------------------- <br />Sdciricity is provided for my booth'^usaJZJYes No 1 t <br />|- am providing an accurate probe■fhermorfeter to measure the hot and co|d holding of potentially hazardous ■ <br />foods during all tim.es of booth .operation: S/Yds No <br />I am providing'trie following hot temperaturedbontrol for the hot holding of all potentially hazardous foods above <br />1356F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, .potato salad, eggs, arid 'dairy products. <br />>?’ ■') -------COUNT Y------- <br />■''dUFoy^-' Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION