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’ll.FAX NO.FROM :■ <br />1. <br />2. <br />3. <br />4. <br />5. <br />* <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Received Time Apr. 9. 2019 11:01PM No. 4908 Fa987of11 <br />l|f» <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />-,-T' . A A<nu H .AAA 0^7^^ TEMP EVEMT <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: Yes g] No <br />I am providing an accurate probe thermometer to measure the hot and cpld holding of potentially hazardous <br />foods during all times of booth operation: 53 Yes |~| No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />Q Camp stove Q Stemo & hotel trays <br /> Double steamer Steam table & Ikls <br /> Electric stove top 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 />24 2013 10:01PM P7 <br />RECEIVED <br />AFi? i g 20® <br />Environmental Health apartmentSANsJOAQUIN <br />------COUNTY------ <br />Grv-:atr>ess crews here. <br />TEMPORARY FOOD VENDOR’S APPLICATION fkz>5X/ 7 2_ [ <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 />1 .Name of Event: <br />The following is information about my organization/business , / <^0/ <br />Name of organization/business: -H AU) Al) Aft* _____ <br />Address: WflDlX /5M/P <br />Phone: Alternate: ( ) <br />List food to be sold or given to the public; KgTTZJ? <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities; ^Yes No <br />Name of facility; T^lM^TPUJkl MA ji nFT'A Phone; ( )_____ <br />Address of facility: ________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fifes, <br />dust and the public) <br />[>3 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 />.TT-f ST <br />' <■