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Environmental Health Department <br />! <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />! <br />5. <br />( <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPPage 7 of 11 <br />I <br />i <br />7. <br />8. <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 EVEN1 <br />07/3/17 <br /> Other (specify): -——--------------------------------— ---------------------- <br />Electricity is provided for my booth’s use: Yes 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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Stemo & hotel trays <br /> Double steamer 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 />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.1. Name of Event VlM I) <br />The following is information about my organization/business: . <br />Name of organization/business: I I | i -------------------------------------------—--------- <br />Address: HU LA'i_______--------------------------------------------- ---------- <br />(M3) Alternate: ( )t------------------------- <br /> <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:*^ Ye^Jf No <br />All food is prepared on-sitej5r is from approved commercial facilities: Yes® No . <br />Name of facility: L ntk UrcWP. l/al-------------r PhPne: «711--------- <br />Address of facilit. yj?) SV. Lnoi__ _ 9&2VO----------:— <br />I am providing a booth with the following: (to prptect 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):__________________________________L/- ■------- -------------------------—---------------- <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: