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\ * <br />Environmental Health Department <br />Date(s): 1. <br />2. <br />Name of organization/business: <br />Address; <br />«5\0)Phone; <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice,Note; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[zf Approved bottled water. <br />E^fon-site hose bib that is connected to a potable water source. <br /> Stemo & hotel trays <br />Eyfsteam table & lids <br /> Other (specify) <br />The following is information about my organization/business: <br />SANJOAOUIN <br />-----COUNTY------ <br />G r t: o t n e s 5 i'j o s h " r c. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16’02 page 7 of 11 TEMP EVENT APP <br />nR/9p/?n93 <br /> Alternate: ( )__ __________ ______ <br />List food to be sold or given to the public: > vio S / 5" <br />I am providing food that is NOT prepared at home: [^Yes No <br />All food is prepared on-site or is from approved commercial facilities: fyfyes No <br />Name of facility:Phone: ( ) <br />Address of facility: <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 />[?fA 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify): x _ _- <br />Electricity is provided for my booth’s use: H 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 operation: fj Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />taST: <br />0 Camp stove <br /> Double steamer <br /> Electric stove top <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 />I.Name of Event: