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Environmental Health Department <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />1868 E. Hazelton Avenue | Stockton. California 95205 I T 209 468-3420(| F 209 464-0138 I <br />EHD 16-02 PnHATnfll V06/29/2023 PegeTofll \ <br />No <br />Treasure the hot and cold holding of potentially hazardous <br />.sjgov.org/ehd <br />„ TEMP EVENT APP <br />)_ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispenser©, or prepackaged foods from approved sources. <br />: SANJOAOUIN <br />------COUNTY------- <br />Greotness grows her«. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />{^Approved bottled water. <br />EJ On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes^5( <br />I am providing an accurate probe thermometer to <br />Yes No <br />ehtrol for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br />^Other (specify) <br />Note: ■ Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />i <br />1.tz w \ V c^pate(s): <br />AA c <br />^^3'7 <br />foods during all times of booth operation^ <br />I am providing the following hot temperature <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />1. Name of Event: Q V S \ A <br />The following is information about my organization/business: <br />Name of organization/business: /X V-Q \ \ V- YS> <br />Phone: 0 Alternate: ( <br />List food to be sold or given to the public: Aaia-C*. <br />eSTCTZ/I am providing food that is NOT prepared at home^2@s^flo I <br />All food is prepared on-site or is from approved commercial facilities: l^Yes No <br />Name of facility: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 />dust and the public) <br />£SsA 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 />areas from the public. <br /> Other (specify): <br />7