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Environmental Health Department <br />1. <br />2. <br /> C <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />| | Approved bottled water. <br />J-M On-sito hose bib that is connected to a potable water source. <br />foods during all times of booth oporation^hYes IJ No <br />9. <br />^'•In <br />meats, tamales, cooked beans, rice, <br />| | Storno & hotel trays <br />I | Steam table & lids <br />| | Other (specify) <br />7. <br />8. <br />C ( <br />'C\ ( i < { <br />SANJOAOUIN <br />COUNTY <br />i. •, hci> <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />smother (specify): L& <br />Note: T he only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />.Date(s):.s£P2±l?L2??!. <br />(7I A booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanablo floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />1868 I-.. I la/olton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 46'1-0138 | www.sjcehd.com <br />( HD IG O? l’n(|0 7 0(H II MP CVI N) API1 <br />0//3/IZ <br />I | Other (specify):_ . . . .. <br />Electricity is provided for my booth's userf^LYcs I ’ I No <br />I am providing an accurate probe thormomotor to measure the hot and cold holding of potentially hazardous <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />| | ('amp stove <br />| | Double steamer <br />| | Electric stove top <br />All food vendors (botli for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator throe (3) weeks prior to this event. <br />1. Name of Event: pESTIVAI. <br />T he following is information about my organization/business: <br />9 <br />Name of organization/business: a -Ll! <br />Address: H zD. <br />13hono: fWi ) » "1 V / Alternate: ( <br />List food to be sold or given to tho public: ------ <br />/ <br />I am providing food that is NOT prepared at homOfT?] Yes | ] No <br />All food is prepared on-sito or is from approved commercial facilities:-)^ Yes (. I No <br />Name of facility: Phone:.(j <br />Address of facility:_ ___ <br />I am providing a booth with tho following: (to protect my unpackagod food and food-preparation areas from flies, <br />dust and the public)