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Environmental Health Department <br />Date(8): 1^1. <br />2. <br />Address: <br />Phone:( <br />■3. <br />4. <br />6. <br />8. <br />9. <br />1 <br /> Stemo & hotel trays <br /> Steam table & lids <br />£3 Other (specify) <br />meats, tamales, cooked beans, rice. <br />7. <br />8. <br />Iqa*2_ 5k» - }>-'S_______ <br /> Aftemate: ( <br /> ' <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br /> On-elte 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 operatton: Yes No <br />I am providing the following hot temperature control for the hot holding of all potenflaUy hazardous foods above <br />135*F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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. <br />I am providing food that is NOT prepared at home: ^Yes No <br />All food is prepared on-site or Is from approved cortwieraa! facilities: Yes No <br />Name of facility: Phone: ( ) <br />Address of faculty: <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 oleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />SANJOAQUIN <br />' -----COUNTY------ <br />Greotnass grows here. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.6jcehd.com <br />E^18-02 PBfl9?of11 TaiP EVENT AFP <br />r '- !r.‘ • <br />All food vendore (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 />1, Name of Evart t>V 04V <br />The following Is Information about my organlzation/busfriess: <br />Name of organization/business: ^\yY\P/I if A <br />List food to be sold or given to the public-