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Environmental Health Department <br />1. <br />2. <br />Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br />^0'Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />SANJOAOUIN <br />------COUNTY------ <br />Great ness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): <br />rT\ 7' <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgoVpOrg/ehd <br />7 zxf 1 I • cMr cVtlN I AlEHD 16-02 Hage ' 01 11 <br />nc/on/onno <br /> Stemo & hotel trays <br /> Steam table & lids <br />Other (specify) ' <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />I.Name of Event:. <br /> Other (specify):_ _ ________ <br />Electricity is provided for my booth's use: O Yes O No <br />I am providing an accurate probev thermometer to measure <br />foods during all times of booth operation: Q'Ves 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 />The following is information about my organization/business: <br />Name of organization/business: Z)///97/Z>ZZ4K.^zry £>LL/)n^/S7- <br />Address: ZZZ?/. ___ <br />(/f/zr 7 ___ Alternate: (^>7 >3^ 6-^33 ( <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br />I am providing food that is NOT prepared at home: 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0'Yes 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 />.00A 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 />meats, tamales, cooked beans, rice,