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3. <br />i* <br />6. <br />9. <br />SAN JOAQUIN COUNTY <br />ENV1ORMENTAL HEALTH DEPARTMENT <br />UM8 Ent HMltwAvenK, Stockton <br />Butam: (2«9)46M42e <br />£ (to protect mytapi <br />7. Electricity is provided for my booth's use: <br />8. I am providing en accurate probe thermora <br />foods during all time of booth operaiion:< b/^ ( ] Yes <br />I m providing the folfowing hot temperature control for the hot hotting of all potentially <br />above 135 degrees Fahrenheit: <br />( ] Camp Stove ( ] Double steamer <br />[ ] Sumo & hotel trays [J Steam table Jt lids <br />| j Electric stove top <br />( ] Other(spedfyX- /U/A <br />TEMPORARY FOOD VENDORS APPLICATION <br />Al! food vendors (both for profit and non-profit) are required to return a signed and cximpletod copy of tins <br />chackUst to the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event LoA A Skdu? Datefe): Tyc^n, <br />2. The following is information about my orgamzation/busness: <br />Name of orgamzatioQ/btetiness: ___________ <br />Address: a “Dr, . <br />Phone: 6?5^7 "4. ^Itemate: I ( <br />List food to be sold or givento the public:er r<x n <br />prnd VAf 4 -S__________ <br />4. 1 am providing food that is NOT prepared at home: M*Yes I )No <br />A« food is prepared*on-rite or isfirom approved commrecial fecilitiea: WYcs ( JNo <br />Name of fecilily: X1 AcKe n- Phone: 3g - I VST <br />Address of feeility: U? {fl ■<>. 9^^^) <br />5. I am providing a booth with the following: (to protect my linpackaged food and food-prepmtim ms fivm <br />files, dust and the public) <br />[ 1A booth with wrils and ceiling coostnicted of either wood, canvas, plastic, rimfar material and fine <br />mesh fiy screening, compieteiy enctosing open food arena, it will also have a smooth and deunable floor <br />(concrete, aaphalt. dean tarps and smooth wood are acceptable) and constrocted to separate food and food <br />preparation areas from the public. <br />( ] Other (specify):_______________ <br />The only operations not required to provide enclosed booths ore those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utenril and hand waiting will he provided in my booth by die following <br />methods: <br />{ ] Approved bottled water. <br />| j On-rite hose bib that is connected to a potable water source. <br />h-^Ofoer (specify): ^5 Ioa b uuCLk-tfrl * <br />'fl Yes (JNo <br />to measure the hot and cold holding of potentially haztedoua <br />> I JNo Pr< texg-etf <br />fall potentially hazaritoos foods