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Environmental Health Department <br />Date(s):1.I.Name of Event: <br />2. <br />»■» <br />Address: <br />( % g ) 4 -.SNOWIEPhone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />KI Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />3> I <br />7. <br />8. <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 /> Sterno & hotel trays <br />0 Steam table & lids <br /> Other (specify) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />6/7 <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 | www.sjgov.org/ehd <br />EHD 10-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />The foilowing is information about my organization/business: <br />Name of organization/business:. Snowie NorCa I____________________________ <br />94 W. Aneno Ln House, cA 9^391____________ <br />65® ^63'07-15 cell <br /> Alternate: ( 6^0 ) 430-3^91 frr'tan Cell <br />List food to be sold or given to the public: ShSV&cA 1C£/ Mini Donate?1 <br />Soda, HoY <br />I am providing food that is NOT prepared at home: 0 Yes No —~~ ' ' , k <br />All food is prepared on-site or is from approved commercial facilities: Rl Yes No <br />Name of facility: S3-TL-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 />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 />■area's from the public. <br /> On-site hose bib that is connected to a potable water source. <br />0other (specify): SeAf-conAaineU Pluming <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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove tA . A • <br /> Double steamer <br /> Electric stove top <br />the festival coordinator three (3) weeks prior to this event. <br />A'AASAN.JOAQUIN <br />-----COUNTY------- <br />• iG’/fliilne.-is qru'.v.-; <br />TEMPORARY FOOD VENDOR’S APPLICATION