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Environmental Health Department <br />copy of this checklist to <br />2. <br />Address:c# Vo5 pc <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />/> re.^-e~ <br />) <br />Date(s): At? // <br />ehd?6-02 HaZelt°n AVenUe ! Stockton’ California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />or/3/17 age 7 of 11 TEMP EVENT APP <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 />^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: O Yes No ------------------——------- <br />I am providing an accurate probe thermometer to measure the hot and cold holding of ootentially hazardous <br />foods during all times of booth operation: Yes No Y f,d-araous <br />1 ^ P/oviding the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sterno & hotel trays <br />S Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SAN JOAQUIN <br />-------COUNTY------- <br />GfcCtness proves <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />!°ur and non-Profit) are squired to return a signed and completed <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1-Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business:. <br />Phone: Alternate: ( <br />List food to be sold or given to the public: /deo^ <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: s Aa. > Cfij-esi Phone: <br />Address of facility:^/ CM <br />' XTandthl putti°c? W'th thS <followin9: (t0 protect ^packaged food and food-preparation areas from flies, <br />BpApSiOnnthrnmn^"r and ^h9 const,;ucted of either wood' canvas- Pl^tic. similar material and fine mesh fly <br />T9; C0™pletely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />are^s fromThe Scand Sm°Oth W0°d aCCeptable) and constructed to separate food and food preparation <br /> Other (specify):