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[ ] Electric stove top <br />Other (specify): _ <br />I®] Yes <br />MYes <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />Business: (209)468-3420 <br />[ JNo <br />[ ]No <br />r—W---I •.c <br />■ <br />,A/' <br />.iir/ <br />^O'pb'^4 <br />- - ~ <br />____ Alternate: <br />4. lam providing food that is NOT prepared at home: r" ~~ <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: O’H-S/k. _________________ phone: <br />Address of facility: <br />5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas <br />from flies, dust and the public) <br />A booth walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh <br />fly screemng, 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 <br />approved dispensers, or prepackaged foods from approved sources <br />6. <br />methods: <br />[ J <br />[ 1 <br />7. <br />8. <br />hazardous foods during all time of booth operation: <br />9. r ... <br />foods above 135 degrees Fahrenheit: <br />[ ] Double steamer <br />[ ] Steam table & lids <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />f°r P?flt and,non-Profit) are required to return a signed and completed copy of this <br />checklist to the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Date(s): <br />2. The following is information about my organization/business: <br />Name of organization/business: <br />Address: -r P- J <br />Phone: / <br />3. List food to be sold or given to the public: <br />—Kij-fk' - <br />are those which sell beverages from <br />Approved water for dunking, utensil and hand washing will be provided in my booth by the following <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: [ JYes ®No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially <br />10 n M —11 __r»1_< .1 . • - r * ' . • \ <br />- • Owl Yes [ JNo /J7 (y <br />I am providing the following hot temperature control for the hot holding of all 'potentiaiify hSdous <br />[ ] Camp Stove <br />[ ] Stemo & hotel trays