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Environmental Health Department <br />i. <br />2. <br />..Address: <br />Rhone: <br />3. <br />4. <br />1 <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:g <br />9. <br />meats, tamales, cooked Deans, rice, <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />SAN JOAQUIN <br />COUN~V <br /> Other (specify): C'XPVYY' VxT< j1 <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 />Note: txampies or potentially hazardous rood include: <br />vegetables, potato salad, eggs, and dairy products. <br />I I On-site hose bib that is connected to a potable water source. <br />□ Other (specify)- VXC VVCktne Qr. ?Tl________________ <br />Electricity is provided for mV 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: Yes No <br />I am providino the following hot temperature control for the hot holding of all ootentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />All food vendors (both tor 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 />1. Name of Event: Q-\Cr,n V\Ck\VA <br />■ i—iwii vixnix i ■ vzvzlx v uulzwix vz /-ii ■ uivn ■ ixyn <br />, YrrezerAr ied <br />pr,n <br />The following is information about my organization/business: <br />Name of organization/business: \\<V\ <br />\U7B CcAk<j? _____ <br />( 7C^\) 70 7(: Alternate: ( ) <br />List rood to be soio or given to the public: <jf<'\ YcAAee ) Yy iAAV | CCX)k \ <br />I am providing food that is NOT prepared at home: Yes l^J^o <br />ah food is prepared on-sit« or is from approved commercial facilities-1 ! Yes IvTno <br />Name of facility: CYC • 77"} —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 />b/f 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 />Date(s): 7 |