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Environmental Health Department Date(s):I.Name of Event: 1. 2. Address: Phone: 3. 4. 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. 9. meats, tamales, cooked beans, rice, 7. 8. Stemo & hotel trays Steam table & lids Other (specify) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP Lt-HO ■’..top’*' SANJOAOUIN COUNTY Greatness grows here TEMPORARY FOOD VENDOR’S APPLICATION ^prxi(/,v________ Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. On-site hose bib that is connected to a potable water source. □"Other (specify): Electricity is provided for my'booth’s use: Q/Yes No ' I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: □Ves No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135OF: Camp stove □"Double steamer Electric stove top All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. The following is information about my organization/bu&iness: Name of organization/business: [ffiOO fv). CPt (<J0^) " HlX) __________ Alternate: ' |UH_Lz List food to be so(d or fliven.t0 the public: 3) HICj (jM I C 1)____ I am providing food that is NOT prepared at home: Yes No All food is prepare^on-site or b from approved commercial facilities: [ Name of facility: TXtl/U/U" Address of facility: LA 0 b | ( < 'YtH} A. I am providing a booth with the following: (to protect my unpa^ka^ed food and food-preparation areas from flies, dust and the public) □"Yes No L Phone: f^lP) 41-fU 9 Y/j 9" set my unpar^kaded food an , .