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Alternate: <br />1 List food to be sold or given to Republic, <br />> <br />Note? <br />J Yes <br />[ <br />[] Stemo & hotel trays [] Steam table & lids <br />«lll <br />1 11 11< <br />ruuF <br />UJk <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HE ALTHDEP ARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />Basinets: (209)468-3420 <br />- <br />9. I am providing the following hot te <br />above 135 degrees Fahrenheit: <br />M Camp Stove [^Double steamer [ ] Electric stove top <br />[ ] Stemo & hotel trays [ ] Steam table & lids [ ] Other (specify): --------------------------- <br />Notes Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />4. I am providing food that is NOT prepared at home: <br />Ail food is prepared on-site or is from approved c <br />Name of fecility: <br />Address of fiicility: <br />KJYes ( ]No <br />sreial facilities: M Yes [ ]No <br />Phone: 7^7 <br /> <2^ <br />5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and foe public) <br />M A booth with walls andceiKngcanstnjctod of either wood, canvas, plastic, similar material and fine <br />me^hfiy screening, completeiy enclosing open food areas, ft wiU also have a smooth and cleanable floor <br />(concrete, asj^ialt, clean tarps and smooto wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ J Other (specify): _____________________ ____ <br />The only operations not required to provide enclosed booths am those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br />methods: <br />M Approved bottled water. <br />H On-site hose bib that is connected to a potable water source. <br />[ ] Other (specify): <br />7. Electricity is provided for my booth’s use: f <br />8. I am providing an accurate probe thermometer to <br />foods during all time of booth operation: <br />araiure <br />R' <br />[JNo <br />the hot and cold holding of potentially hazardous <br />res [ ] No <br />for fire hot holding of all potentially hazardous foods <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and nan-profit) are required to return a signed and completed copy of this <br />checklistSo foe festival coordinator three (3) weeks prior to this event <br />1. Name of EventZ^^ ; Date(s): <br />2. The following is mformatian about my organizahon/business: / <br />Name of wgmzation/business: <br />Address: <br />Phone: SLb^