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Environmental Health Department <br />SEPT) |(J JI1.Date(s): <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Pago 7 of 11 www.sjcehd.com <br />TEMP EVENT APP <br />7. <br />8. <br />are required to return a signed and completed copy of this checklist to <br />Jnh Hazelton Avenue I Stockton, California 95205 | T 209 468-34201 F 209 464-0138 I <br />07/3/17' ■ <br />SAN.JOAQUIN <br />/ ------COUNT Y------ <br />Greotness gro»v$ here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit). <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: L0DI GRAPE ESTIVAL <br />The following is information about my organization/business: <br />Name of organization/business:; <br />Address: <br />Phone: | C-? 4, Alternate: ( <br />List food to be sold or given to the public: r>^> (' j , <br />I am providing food that is NOT prepared at home: [C^Yes No <br />All food is prepared on-site or is from approved commercial facilities: f^Yes No <br />Name of facility: Phone: ( ) <br />Address of facility:____________________ ______________ <br />* ^sTand th^ 3 ^bl°^ W*^ Pro^ec^ my unpackaged food and food-preparation areas from flies, <br />1Z] 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 />areas frorrTthe public^ Sm°Oth W0°d are accePtable) and constructed to separate food and food preparation <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 /> Other (specify): <br />Electricity is provided for my booth’s use: 10 Yes No “ <br />1 the tlOt and C0,d to,dln3 0,p0,en,,a"y tod0US <br />1 a^£cVldlng the fo,lowin9 hot temperatufecontrol for the hot holding of all potentially hazardous foods above <br /> Camp stove Q sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top £0 other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.