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Apr 26 18 12:07p p.1B&EHospitality G 296-6432o Inc <br />Environmental Health Department <br />a signed and completed copy of this checklist to <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />are those which sell beverages from <br />6. <br />9. <br />7. <br />8. <br />SAN JOAQUIN <br />C O U N T Y <br />Stemo & hotel trays <br /> Steam table & lids r <br />XI Other (specify) <br />include: meats, tamales, cooked beans, rice, <br />Date(s): 3?// // <br />b- __________ <br />=_5-/ocZZ>r( z 9/'^-^7 <br />Alternate: ) ^17^3 9^ <br />public: € H } <br />■ - pTO^ <br />All food is prepared on-site or is from approved commercial facilities: Rl Yes No <br />Name of facility: pho . J <br />Addressor^Z^V ~~ <br />XSTe<to unpadiged and tad-preparation areastram Wes. ‘ <br />«"« —b dy asphalt, dean tarps and smooth X2 a” aSSbte) aid inse Z Irt™0' and Cleanal’te 'l00r '“"“k <br />areas from the public. acceptable) and constructed to separate food and food preparation <br /> Other (specify): <br />Note- which se"bevera9es fnm <br />Approved water for drinking, utensil and hand washing wiii be provided in my booth by the followng methods; <br />71 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 No - ---------------------------------------------------------- <br />1 ^nHcrOdVdlr19 accura.t® probe ^ermometer to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation:^ Yes No y nazaraous <br />' T!foeViding 1,16 fo,lowi"9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food <br />vegetables, potato salad, eggs, and dairy products. <br />ehd loz HazGlton Avenue I Stockton, California 95205 J T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 Pa9e 7 Of 11 TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />fol frSi ve:ndorsJb0{h for Profit and non-profit) are required to return <br />the festival coord/nator three (3) weeks prior to this event. <br />1- 1-Name of Event:.-PeCu.^4 cd"' 'Up' fezK <br />The following is information about my organization/business: <br />Name of organization/business:Q,, <br />Address: 5 A57 <br />List food to be sold or given to thepi <br />providing food that is NOT prepared at homeJ^Yes Q No ‘ <br />- --------1 approved commercial facilities:^ <br />d'Q.i /ylk G^/A^Z,^7. p <br />.99^^ -------- -- <br />providing a booth with the following; (to protect my