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Environmental Health Department <br />I.Name of Event1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, <■ <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 4644)438 | w^.sjgo^otgfohd^ <br />EHD 16-02 <br />06/19/19 <br /> Other (specify):—------------------------- <br />Note: The only operaUons 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 />SANJOAOUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify):_ _____—---------------------------—------------------------------------------------- <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods ah' <br />135°F: m <br /> Camp stove S Stemo & hotel trays <br /> Double steamer O Steam table & lids <br />Q Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this chec' <br />the festival coordinator three (3) weeks prior to this event <br />PaofcBfr VO^Datefs): *^3 <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: 33/P N. ;--------------- <br />Phone: ( Alternated )-------- --------------------------------- <br />List food to be sold or given to the public: <br />pF\POt <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes Q No <br />Name of facility: Phone: ) <br />Address of facility: Qtvp -MA /gACy 5 ------------------- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fl <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine me- <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (cone <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparab. <br />areas from the public.