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Environmental Health Department <br />1. <br />2. <br />OA <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />Page 7 of 11 <br />Scanned with CamScanner <br />Li1!’ <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHDia-02 Page 7 of 11 TEMPEVENT APP <br />07/3H7 <br />are required to return a signed and completed copy of this checkfist to <br />__Date(s): <br />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: 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 above <br />135*F: <br />[3 Camp stove Stemo & hotel trays <br /> 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 />Greotresj jronj here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AB food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event <br />I.Name of Event <br />The following is information about my organization/business: <br />Name of organization/business: 77? <br />Address: </ lAZ/rT/C/g <br />£3 * ) -^3^ - (p(^|^|Alternate: ( ) <br />Let food to be sold or given to the public: 4 <br />I am providing food that is NOT prepared at homeS^Yes No <br />AB food is prepared on-site or is from approved commercial fadlities:^gYes No <br />Name of facility: domey-g _______________phone; ( ____________________ <br />Address offaciirtyr-^ TUVaqj 5^°CAtA^r>> <br />* ^ust'and th^ 8 W^' ^°"ow,n®' Pro*ec* my unpackaged food and food-preparation areas from flies, <br /> A booth with walls and ceding 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. <br />Appro; <br />C6