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Environmental Health Department <br />1.Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />‘rSq<Yio as <br />e. <br />6. <br />9, <br />meats, tamales, cooked beans, rice, <br />Pasv7of 11 <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />b^BJerno & hotel trays <br />E^Steam table & lids <br /> Other (speolfy) <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 waterfbr drinking, utensil and hand washing win 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 />1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth cparatton: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209468-34201 F 209464-0138 | www.sjcahd.com <br />EHD1S02 Paso 7 of 11 TEMP EVENT APP <br />070/17 <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 />1. Name of Event: r <br />The following Is Information about my organlzatforVbusiness: <br />Name of organization/buslness: <br />Address: P3IA Pacific- |\,IPm.u4L <br />r/arfo qm-gpiD __ Alternate: <br />Llatfoodtobosoldor given to (he public: A C <br />I am providing food that Is NOT prepared at home: E^es No <br />All food Is prepared cn-slte or Is from approved commercial facilities: {^es No <br />Name of facility: CM (XS (1 ____________Phons: ( 1 <br />Address of facility:__________________________________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files, <br />dust and the public) <br /> A booth with walls and celling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It wll 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 />SAN JOAQUIN4 ------COUNTY— <br />Greatness grows here, <br />TEMPORARY FOOD VENDOR'S APPLICATION