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I Environmental Health Department SJ I 1. Name of Event:1.Date(s): 2. 5 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. 0 On-site hose bib that is connected to a potable water source. (ho hot and cold holding of potentially hazardous 9. s meats, tamales, cooked beans, rice, Noto: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. ) 7. 8. Name of organization/business: !^C'\ (J 1* SAN JOAQUIN ------COUNT Y— (: (<■ j t n ess y i <>w s her?, TEMPORARY FOOD VENDOR’S APPLICATION _______ Alternate: ( C p- i-K The following is information about my organization/business: Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. 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. <y- l-xT £4-P (j ( Other (specify):_ _____ Electricity is provided for my booth’s use: I I Yes ZF No I am providing an accurate probo thermometer to measure foods during all times of booth operation: 0 Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove .<Q Sterno & hotel trays Double steamer Steam table & lids Electric stove top Other (specify) 1868 E. Hazelton Avenue | Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sigov.org/ehd EHD 16-02 Pago 7 of 11 TEMP EVENT APP 06/19/19 I am providing food that is NOT prepared at home: 0 Yes 0 No All food is prepared on-site or is from approved commercial facilities: 0 Yes No Name of facility: \: ^t} 1) Phone: () Address of facility: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ^5 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. Address: ..5^1^______ List food to be sold or given to the public: fApl