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Environmental Health Department <br />All food vendors (both for profit nnd non-profit) nro required to return a signed and completed copy of this checklist to <br />Date(s): ()(3^^-1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />) <br />5. <br />bmS Lo'aPv: <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br /> Other (specify):___________ __________ <br />Eiecthcrty is provided for my booth's use: Yes PRJo <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />a. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> A booth with waBs and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely endosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the pubfic. <br />0 Other t QCf m L..-,. <br />* q rca rd <br />Note: The only operations not required to provide endosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 7 of 11 TEMP EVENT APP <br />06/19/19 <br />Note: Examples of potentially hazardous food Include; <br />vepetabtes, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br />Q Double steamer <br />O Electric stove top <br />SANJOAOUIN <br />— COUNTY------ <br />Grcomrsi qrous hrie <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: \p01A (7^/11H <br />The following is information about my organlzatlon/busInGBs: <br />Name of organizabon'businoss: <br />Aq vrmcr tn 993^0 <br /> Alternate: ( ) <br />List food to be sold or given to the public: <br />I am presiding food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes 0 No <br />Name of facility:Phone: £ <br />Address of fadHty:, <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and trie public)