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t <br />Environmental Health Department <br />I . <br />1. Name of Event: 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />Io <br />9. <br />7. <br />8. <br /> Sterno & hotel trays <br />Q Steam table & lids <br />Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br />4 Z;- <br /> On-site hose bib that is connected to a potable water source. <br />[if Other (specify): _ firfA yH 6U Jiff gw, <br />Electricity is provided for my booth’s use: Yes <br />I am providing an accurate probe thermometer to measure the hqt <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing an accurate probe thermometer to measure the hqt ind cold bolding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />-—COUNTY <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is information about my organization/business: <br />Name of organization/business: <br />i r'/}, <br /> Alternate: ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0 Yes No ' , J <br /> 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <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 />Ove <br />meats, tamales, cooked beans, rice, 1 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this ck <br />the festival coordinator three (3) weeks prior to this event. / A / ’Ih <br />All food is prepared on-site or is from approved commercial facilities: ^Yes No <br />Name of facility: A/uZh A Phone: <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparatitfn areas from flies, <br />dust and the public)