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Environmental Health Department <br />b <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />I <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EKOie-02 PafleTolll 7EMP EVENT APP <br />07/3/17 <br />SANJOAQUIN <br />— COUNTY------ <br />Grfi l.i'i groc •. lii-ii . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> J <br /> Other (specify):-------------------------------------------------------------------------------------- <br />Electricity is provided for my booth's use: Ltfres LI 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: P'Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />[frCamp stove Sterno & hotel trays <br />[flBouble steamer O Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />: [i^Ves No <br />__________________ ABhone: (^/) <br />>oth with the follo\4ng: (to protect my unpackaged food and food-preparation areas from flies, <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 />©approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Name of organization/business:__ <br /> <br />List food to be sold or given to the public^^^^-------, <br />x . /a Sa. rY <br />I am providing food that is NOT prepared at home: [jXes No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: fi'**'\* <br />Address of facility:. rsr. <br />I am providing a booth with the fol— „ . . . . <br />dust and the public) <br />rWbooth 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 />All food vendors (both for profit and non-profit) are required Io return a signed and completed copy of this checklist to <br />the festival coordinator three pi weeks orior to this event. . x- <br /> 1. Name of Event. k' A - <br />The following is information about my organization/business, <br />4 t