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♦ <br />• Environmental Health Department <br />I Lf Iom1. <br />2. <br />Address: C.A <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Note. The only operations not required to provide enclosed booths <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 />8. <br />y -y | y <br />y ... . <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 E 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 ail potentially hazardous foods above <br />I oD i . <br /> Camp stove gj sterno & 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 />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this <br />f.Name of Event: <br />are those which sell beverages from <br />SAN JOAQUIN <br />COU NTY— <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Hazeiton Avsnue I Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 j www.sjgov orq/ehd <br />^g^02 Of 11 J?EMp E^NT App <br />are required to return a signed and completed copy of this checklist to <br />event. <br />D fc C £ ^Tnmefs)- <br />The following is information about my organization/business: <br />Name of organization/business: <br />__XJo A/-T^/qcy cy <br />I ) X.C XX 1_____ Alternate: ( ) <br />List food to be sold or given to the public: PfAJ E KI! > C UEXf <br />I am providing food that is NOT prepared at home: K. Yes No <br />All food is prepared on-site or is from approved commercial facilities: ® Yes Q No <br />Name of facility: XWiv f bexX £ f Phone: ? - ? < / <br />Address of facility: 3 Xf Q Ai 7^. ACV HP , Kf} ‘JSyAE <br />1 ^sTand the 3 W'th fol,0Win9: protect my unpackaged food and food-preparation areas from flies, <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 frorrTthe^^f Sm°Oth W0°d are accePtable) and constructed to separate food and food preparation <br /> Other (specify):