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Environmental Health Department <br />1.1. Name of l.-vcnt: XQDI GRAPH FESTIVAL. <br />2. <br />Phono: <br />3. <br />4. <br />6. <br />I I Other (specify): <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods:6. <br />I | Approved bottled water. <br />I J On-site hose bib that is connected to a potable water source. <br />9. <br />tn eats, tamales, cooked beans, rice, <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 />I J A booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and clcanablo floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to soparato food and food preparation <br />areas from tho public. <br />1860 E. Hazelton Avenue | Stockton, California 952.05 | T 209 468-3420 | I- 209 464-0138 | www.sjgov.org/ohd <br />H in 1G-02 I ’«fl0 7 I>f 11 II -Ml* I :vi -NT Al >1 ’ <br />06/19/19 <br />/. <br />8. <br />I | Sterne & hotel (rays <br />[ | Steam table A lids <br />I I Other (specify) <br />I am providing food that Is NOT prepared at home: |)<J| Yos |’J No <br />All food is prepared on-site or Is from approved commercial facilitios.^'l Yes [ J No <br />Name of facility:Phone:.() <br />Address of facility:. <br />I am providing a booth with tho following: (to protect my unpackagcd food and food-preparation areas from flies, <br />dust and tho public) <br />SANxIOAOUIN <br />.....COUNTY <br />(.a col rii.’ss yrovvs hrit.'. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />List food to bo sold Qr_giverLtQ.thg public; Alternate: ( ) <br />................ — <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. <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I | Ollier (specify):__ <br />I ilectricity is provided for my booth’s use: |._ | Yes L J 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: | I Yes f | No <br />I am providing tho following hot temperature control for (ho hot holding of all potentially hazardous foods above <br />135T: <br />I | Camp stove <br />| | Double steamer <br />I | Electric stove top <br />__DaletsJSHlTEMBH?. .14.7 11 <br />The following is Information about my organlzation/buslncss; Namo of organlzation/buslnoss: <br />Address: 7^/__________________ <br />___________—_______________________________________