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SAN JOAQUIN Environmental Health Department <br />the festival coordinator t <br />Cott1.Date(s): <br />2. <br />3. <br />4. <br />UoY /lol) ki7CH(^ <br />5. <br />6. <br />water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />I.Name of Event: <br />The following is in'ormation about my organization/business: <br />Name of organiza ion/business: Mb1/ 'lloX) <br />Address: <br />Phone: <br />Phone: (tyll) O1/?4/ <br />I <br />^cH thpccy Divn, sacMwkto , w <br />) —^47^/ Alternate: ( ) <br />List food to be sol<I or given to the public: Vull-fcD Ppllk <br />use: fe'Yes O No <br />iccurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />i: H Yes No <br />1868 4. Hazelton Avenut <br />EHD 16-<2 <br />06/19/19 <br />are those which sell beverages from <br /> Stemo & hotel trays <br />E/f^team table & lids <br />Mother (specify) Gflltl <br />of potentially hazardous food Include: <br />. . are required to return a signed and completed copy of this checklist to <br />tree (3) weeks prior to this event. . <br />LoDl Cowmc Con <br />(Mik <br />lots: The only o aerations not required to provide enclosed booths <br />approved d spensers, 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 />ZJ Approved bottle d water. <br />^^n-site hose bit that is connected to a potable <br />j] Other (specify):_____________ <br />Electricity is provide id for my booth's <br />am providing an iwu.uiv uidmvi <br />foods during all ti nes of booth operation: _ _ <br />am providing the oilowing hot temperature control for the hot holding of all potentially hazardous foods above <br />1135 Fz <br />J Camp stove <br /> Double steamer <br />U Electric stove to ) <br />tote: Examples <br />vegetables, potato salad, eggs, and dairy products. <br />| Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pago 7 oT 11 TEMP EVENT APP <br />IQ'other (specify): <br />Alternate: ( )__________________ <br />'Tbrs <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All fcod vendors (both for profit and non-profit) <br />/0 ■'favc/t <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /><-r>hoif r.i ~ - --j are acceptable) and constructed to separate food and food preparation <br />areas from the put lie. <br />I <br />I am providing foo I that is NOT prepared at home: B'Yes No <br />All food Is prepare ion-site or is from approved commercial facilities: E^Yes No <br />Name of facility: UoY flol) _______Phone: (^1^ ) ^09- 0^7^_________ <br />Address of facility: foPUV fA 95^^ ____________________ <br />1 T^d th9 3 l°*)h W'Ul the followin9: Pro,ect my unpackaged food and food-preparation areas from flies, <br /> A booth with w ills and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />asphalt, clean tarp s and smooth wood