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• <br />Date(s): I.Name of Event: 1. <br />2. <br />Address: <br />Phone: <br />4. <br />5. <br />6. <br />O Approved bottled water. <br />9. <br />7. <br />8. <br />“ i , <br />Environmental Health DepartmentSANJOAQUIN <br />------COUNTY------ <br />Greotness jjron $ here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> On-site hose bib that is <br />Ej Other (specify): * v ,------------- --------t-----------------------------------------y------------- <br />Electricity is provided for my booth's use: LJ Yes E_J No , <br />I am providing an accurate probe thermometer to measure th/ hot andAoldHolding of potentially hazardous <br />foods during all times of booth operation: GjYes No <4 ... <br />I am prnvidinn thA fnllnwino hot temoerature control for the hoi holding of all poten' <br />135°F: <br />Q Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/1S <br />The following is information about my organization/business: <br />Name of organization/business: <br />/ 7 5 ? (/i. <br /> Alternate: ( )J______ : <br />3 list food to be sold or giyep to the public: flic i <br />A ram providing food that is NOT preparea at home: E Yes No <br />All food is prepared on-site or is frormapproved commercial facilities: Yes No / ✓ / Z <br />Name of facility: Phone: (( <br />Address of facility: / ?' S P <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 />| | A 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 />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 /> it is connected to a potable water source. <br />Other (specify): /v I ____ ------- -------------------- <br />'lectricity is provided for my booth's use: LJ Yes LJ No <br />js during all times of booth operation: [Z/Yes No ‘ , <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays 7/1 / <br />meats, tamales, cooked beans, rice,