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Environmental Health Department <br />1. Name of Event:1. <br />2. <br />(A Q{S2m>Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVEN! <br />07/3/17 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />i-site or is from approved commercial facilities: <br />booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />SANJOAQUIN <br />] ------COUNTY------ <br />' Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />j Yes No _ <br />Phone: (2Cf?) <br />□ Other (specify): /V j ________________________ <br />Note: The only operations not required to provide enclosed booths <br />The following is information about my organization/business: <br />Name of organization/business: <br />Il7 ,/J. Sotc/fxfrvrrk) <br /> Alternate: ( )________________ <br />List food to be sold or given to the public: (LiPC. 't <br />I am providing food that is NOT prepared at home: Yes <br />All food is prepared on-site_or is frorn approved coi <br />Name of facility: <br />Address of facility:t <br />I am providing a L------ . . <br />dust and the public) <br />[TfATiooth 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 />i <br />Date(s): 5 S IT <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 />Cl Vrr6 <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />B'Xpproved bottled water. <br />[vfbn-site hose bib that is connected to a potable water source. <br /> Other (specify): ------- <br />Electricity is provided for my booth’s use: Yes BIno <br />I am providing an accurate probe thermometerjo measure <br />foods during all times of booth operation: es No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove O Sterno & hotel trays <br />^Double steamer [ZTsteam table & lids <br /> Electric stove top Other (specify)