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Environmental Health Department <br />1.1. Name of Event: Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br /> Sterno & hotel trays <br /> Steam table & lids <br />(Xd Other (specify) <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 />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />UK. <br />The following is information about my organization/business: <br />Name of organization/business: <br />( ^ ^ ) 3^? • 1 Alternate: 5 ~ 3 <br />List food to be sold or given to the public: f <br />I am providing food that is NOT progared at home; rl Yes |~] No <br />All food is prepared on-site or isdromapp roved commeroial-faGilUias^fYes No y <br />Name of facility: M LI Phone: (<O^) <br />Address of facility: IT* P/l j J <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 />«// <br /> On-site hose bib that is connected to a potable water source. • i <br />Other (specify):. (.e/t rtoMyti(Aid <br />Electricity is provided for my booth’s use: Q Yey® No 1 <br />I am providing an accurate probe thermometer to measure thahftt and cold holding of potentially hazardous <br />foods during all times of booth operation: |H Yes No /C/ <br />I am providing the following hot temperature control for the hot tiblding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> A 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 />[/(other (specify):, <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.