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Environmental Health Department <br />i. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, hce. <br />Scanned with CamScanner <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 | vww.sjcehd.com <br />EHD 1642 Pag® 7 of 11 TBXPEVWAPP <br />07/3/17 <br />7. <br />8. <br />SANJOAQUIN <br />------COUNTY------- <br />Greatness grc^s here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />I.Name of Event pi VI f <br />The following is information about my organization/business: 1 <br />YV\ <br /> Alternate: M'M' ~~~~~ <br />r <br />VC VQ <hA 1C V Q-P Vy \ C cO <br />\ V 0. . VXoY>C_^ ( U/ ckoOcAC <br />I am providing food that is NOT prepared at homff rjp<es Q Nn V) <br />I < • • <br />Name of organization/business: el <br />^5^0 uO W\ CLrv\-V\Q <br />List food to be sold or given to the public: Vcv<x \<^ Vq <br />, VP-Co, - VXor/e-iL I , <br />I am providing food that is NOT prepared at homK [jp^es No . <br />Al food is prepared on-site or is from approved commercial facilities: [JjYes No <br />Name of facilrtyX^CJfX\ V-Ci /Wa-T^s Vv. Y \— Phone: I <br />Address of facility: p Q ■kYV--Q <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 /> 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 />areas frorrT^ie'pubfc30^ Sm°Oth W0°d are acceplable) and constructed to separate food and food preparation <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. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />□ Approved bottled water. J <br />□ On-site hose bib that is connect^to a potable water source. <br /> Other (specify):____________ / <br />Electricity is provided for my booth's use: Yes [P'hJo - ------------------------------------------------------- <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 0-No n <br />' a^r?vl<iin9 the fo,,owin9 hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F, <br />CJ Camp stove Q Stemo & hotel trays <br /> Double steamer I steam table & lids <br /> Electric stove top / r //) Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.