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5:44PM P28 2013FROMFAX NO.ig. <br /> Date(s): 1. <br />2. <br />' i ‘ <br />Address: <br />Rhone: <br />List food to be sold or given to the pubtic:3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing wifl be provided in my booth by the following methods;6. <br /> Approved bottled water. <br />F~l On-site hose bib that is connected to a potable water source. <br />8. <br />9. <br />meats, tamales, cooked beans, rice. <br />0 A booth with watts 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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0 other (specify); we also dearwrap and put lids on the trays. <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 /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Other (specify):_______ ________________________________ <br />Electricity is provided for my booth’s use: Q Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Environmental Health DepartmentSAN JOAQUIN <br />------COUNTY <br />R^Ry/qOD VENDOR’S APPLICATION ^^^773 <br />/nonprofit) are required to return a signed and completed copy of this checklist to <br />!r thVee (3) weeks prior to this event <br />Manteca Farmer^ Market ■yyJb/r<? A/l gjl <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 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pao« 7 Of 11 TEMP EVENT APP <br />07/3/17 <br />Received Time Apr. 24. 2019 6:47PM No. 4955 <br />foods during all times of booth operation: O Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF: <br />O Camp stove <br />O Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: 0 Yes Q No <br />AH food is prepared on-srte or is from approved commercial facilities: 0 Yes No <br />Name of facility: Rosa's Portuguese Bakery phone; ( ) <br />Address of facility;2251 jackson ave Escalon ca 95320 _______ <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 />TEMPQL <br />All food vendors (both/o/pratikanj/ <br />the festival coordinator three (3) wee <br />z - A^efnate:( ogg ) ^5-2943 <br />filletj cfoissayrt, pastries,turn overs,canolies, Portuguese bread <br />— , ‘if <br />I.Name of Event <br />The following is information ^bout my qjganization/business: <br />Name of o^nization/businessf Rosa’s Portuguese Bak^y <br />2251 Jackson ave Escalon ca 95320 ____ <br />- <br />(209 ) 585-8961