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Environmental Health Department <br />Date(s): 10/16/20211. Name of Event: Ripon Main Street Day1. <br />The following is information about my organization/business:2. <br />Address: <br />516-8768)Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />N/A <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />M Approved bottled water. <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 /> Sterno & hotel trays <br />0 Steam table & lids <br />[X] Other (specify) <br />Name of organization/business: Trail Blazing Nut Roasters DBA Totally Nutz <br />6354 Snedigar Rd Oakdale Ca <br />(209 ) 502-1818 <br />List food to be sold or given to the public: Cinnamon Glazed Almonds Cashew and Pecans <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />1 —, — . . . -rriin r-\ /r-M-r aiEHD 16-02 Page 7 of 11 • —• <br />06/19/19 <br />jX] 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 />I am providing food that is NOT prepared at home: 01 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes [ ] No <br />Name of facility: ON-SITE 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 />Alternate: (360 <br />0 Other (specify):__________________________________________________________ <br />Electricity is provided for my booth's use: 0 Yes [X] No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0 Camp stove <br />0 Double steamer <br />0 Electric stove top <br />SAN JOAQUIN <br />- ------COUNTY------- <br />Grcoicesj g. o s .rt <br />TEMPORARY FOOD VENDOR’S APPLICATION