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r <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event: 1. <br />2. <br />rXAAddress <br />Phone <br />b J13 <br />a <br />4 <br />a? <br />5 <br /> Other (specify) <br />6 <br />9. <br />meats, tamales, cooked beans, rice, <br />13 <br />7 <br />8 <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 />SAN JOAQUIN <br />-COUNTY <br />I <br />I <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods' <br />Approved bottled water <br />(vfon-site hose bib that is connected to a potable water source. <br /> Sterno & hotel trays <br />[r Steam table & lids <br /> Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www sjcehd com <br />EHO 16-02 pa ' -z , ,, TEMP EVENT APP <br />07/3/17 I <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) 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/^(VklCrx______. <br />Alternate: J 1 ^Z.. <br />f-bcxJ- <br />The following is information about my organization/business: <br />Date(s): )Z/7/2.< <br /> Other (specify) /_____________________________________________________ <br />Electricity is provided for my booth s use. E3 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 operation: H Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Name of organization/business: <br />V- 3 c C(U <a <br />CjoOC)______ <br />List food to be sold or given to the public C — <br />I am providing food that is NOT prepared at home. Q^Yes No / <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility. 6 A- ■L'v'A''y Phone' (4^ <br />Address of facility. 7 (/i,’.'A *'tk- L>A >V- <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 />PfA 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