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Date(s): <br /> <br /> <br />[ 1 Sterna & hotel trays [] Steam table & lids <br />SAN JOAQUIN COUNTY % <br />ENVIORMENTAL HEALTH/DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 9SM8 <br />Business: (209)468^420 -*•* 'JMiWirwflWC Wh-nr—“rrir~— -• ■ — -- <br />foods during ail time of booth operation: <br />9. I am providing the following hot: temperature <br />above 135 degrees Fahrenheit. <br />M Camp Stove [ ^Double steamer (] Electric stove top <br />[ ] Stemo & hotel trays [ ] Steam table & lids [ 1 Other (specify): ____________— <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and. non-profit) are required to return a signed and completed copy of this <br />checklist the festival cocndinatortiinte (3) wetta prior to this event <br />1. Name of Event:Date(s): -------- <br />2. The following is information about my organiration/business: y p <br />Name of or^nizationfousiness: —— <br />Address: f ....____L------------—-------- <br />Phone: ^07 Alternate:_^Z <br />3. List food to be sold or given to the public: <br />“i <br />']¥«» llNo <br />aeaswe the hot and cold holding of potentially hazardous <br />tfYes [JNo <br />rot for foe hot holding of all potentially hazardous foods <br />4. I am providing food feat is NOT prepared at home: (<’$ Yes ( ] No <br />All food fo prepared on-site or is ftom approved commocialfiteilities: [^Yes [ JNo <br />Name of facility: , Phone: J^7 <br /> Address of fscitify: ./P 77J"" ________ <br />I am providing a booth with foe following: (to protect my unpackaged food and food-preparation areas from <br />' flies, dust and foe public) <br />M A booth with walls and ceiimg constructed of either wood, canvas, plastic, similar material and fine <br />mwh fly screening, completely enclosing open food areas. It will also have a smooth and cleanabte floor 1 <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from foe public. <br />[ J Otter (specify): ..........................;.................. —7-----------------—— <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 />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 />On-site hose bib that is connected to a potable water source. <br />[ ] Other (specify): <br />7. Electricity is provided for my boofo’s use: K <br />8 I am providing an accuwate prob© thennometer to 1 <br />[