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< <br /> <br />£■ <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />ehd HaZelt°n AV6nUe 1 Stockton' California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />P^rofll TEMP EVEN!TEMP EVENT APP07/3/17 <br />7. <br />8. <br />Environmental Health DepartmentSAN JOAQUIN <br />------COUNT5*------ <br />Greotness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />/I <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1. Name of Event: nn intern .1 <br />Note: The only operations not required to provide enclosed booths are <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 />Mother(specify^nbrnvA k <br />Sectnciiy is provided for my booth's use: Yes No1 X xj...! 1 — \ <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: jS'Yes No <br />1 Pr°vidin9 following hot temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove Q] 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 />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 />areasfronUhe^bf Sm00t*1 woocl are acceptable) and constructed to separate food and food preparation <br /> Other (specify): <br />Address: <br />i — Alternate: ( ~F\ ( <br />List food tobe>spjd or given to the public: <br />I am providing food that is NOT prepared at home: QEfYes No y <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility O Q - uAgJL <br />Address of facility:____ _________ <br />’ ^st^d th^ 3 ^bf3^ W'^1 ^'e ^°"ow'nP: Pr°tect rr|y unpackaged food and food-preparation areas from flies, <br />are required to return a signed and completed copy of this checklist to <br />1. Name of Event: -i_i. i ai WG L x hr Hy A) " tS. 18 <br />The following is information about my organization/business: L-, <br />Name of organization/business: ....L111 v-1 H i rt. A erkrr <br />~ ' O. 95^ <br />3fes No <br />Phone: /___