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Date(s): <br />3. <br /> <br />6. <br />[ ] Stemo & hotel trays [ ] Steam table & lids <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CsaBif®rate 95205 <br />Business: (209)468-3420 <br />n <br />)Yes []No <br />lieasure the hot and cold holding of potentially harardous <br /><¥es [JNo <br />rot for the hot holding of ail potentially hazardous foods <br />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 water for drinking, utensil and hand washing will be provided in my booth by the ioltowing <br />methods: <br />M Approved bottled water. <br />M 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: ' <br />8. lam providing an accurate probe thermometer to <br />foods during all time of booth operation: <br />9. I am providing th© following hot temperature <br />above 135 degrees Fahrenheit: <br />Camp Stove [ ^Double steamer [ ] Electric stove top <br />[ ] Stemo & hotel trays [ ] Steam table & lids [ ] Other (specify): --------------------------- <br />Note: 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: [^Yes [ ]No <br />All food is prepared on-site or is from a^xroved commercial fecilities: Yes ( ] No f. <br />Name of facility: phone: <br />Address of facilityT^ C? A S.<2,gs—-------------- <br />5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation Meas from <br />flies, dust and the public) <br />[ -4 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mebh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable ftoor, <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ ] Other (specify): —--------------------------------- -— <br />Note: <br />'inElWOKA W FOO® VEN®O»’S A»1U(CATHOH <br />All food vendors (both for profit rad non-profit) are required to return a signed and completed copy of this <br />checklist to the festival coordinator three (3) wpeksgior to this event. <br />1. Name of Event: -------- <br />2. The following is information about my organization/business: y <br />Name of orranization/business: <br />Address: ------------------- ---------------- <br />Phone: 7^?-5^7^______ z Alternate: <br />List food to be sold or given to the public: