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?/toS/7V3y <br />Environmental Health Department <br />to the festival coordinator three (3) weeks prior to this event. <br />1.Date(s):I.Name of Event: Xodl Grape Festival <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />Approved waler for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. , <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 />SAN JOAQUIN <br />COUNTY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Sterno & hotel trays <br /> Steam table & lids <br />pother (specify) 1/^^^ <br />meals, tamales, cooked beans, rice. <br />7. <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 4 64-0138 | www.sjgov.org/ehd <br />EH0 16-02 Pag* 7 dll TEMP EVENT APP <br />O6ri»l0 <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:^Yes O No <br />I am providing an accurate probe thermorneler to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operationYes O No <br />I am providing the following hot temperati/recontrol for the hoi holding of all potentially hazardous foods above <br />135eF: <br />O Camp stove <br /> Double steamer <br /> Electric stove top <br />^,l„fOo^X?ni?ors (b,olh f°r Pr°M a9d non-profit) are required io return a signed and completed copy of this checklist <br /> <br /> yl/t„ — 7/^ <br />The following Is Information about my organization/business: / <br />Name of organizatlon/business: kJC <br />Adcjross: (L_/ <br />(Vp 69 Alternate: ( ) <br />List food to be sold or given to the public: C<^>1~ * <br />I am providing food that is NOT prepared at homo:^l Yes No <br />All food is prepared on-site or Is from approved commercial faciriliesf^Yes O No <br />Name of facility: Phone: ( ) <br />Address of facility: .__________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />^A booth with walls and celling 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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify):