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muMinir* <br />3. List food to be sold or given to die public: <br />6. <br />9. <br />----- ~ [^Double steamer <br />[ ] Stemo & hotel trays [ ] Steam table & lids <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />Business: (209)468-3420 <br />• <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this , <br />. jrdinator three (3) weeks prior to this event <br />______ Datefs):-^- ^0^ 7^ f ( <br />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 <br />methods: <br />M Approved bottled water. <br />M On-site hose bib that is connected to a potable water source. <br />[ ] Other (specify): <br />7. Electricity is provided for my booth’s use: <br />8. ] <br />__ Alternate: <br /> , fdYes []No <br />1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all time of booth operation: [ ]Nd <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />above 135 degrees Fahrenheit: <br />Camp Stove [^Double steamer [ ] Electric stove top <br />[ ] Stemo & hotel trays [ ] Steam table & lids [ 1 Other (specify): ------------------------------ - <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />4. 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: [ ,x^ Yes [ ] No <br />Name of facility: /aPhone: <br />Address of facalityT^^Z^-^j^^—^7------------- <br />. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />a booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />me^h fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ ] Other (specify): _______________ ________———--------------— <br />Note: <br />checklist to the festival cooi <br />1. Name of Event:^ — <br />2. The following is information about my organization/business: <br />Name of organization/business: <br />Maks's;, <br />Phone: 7 7^7-^5^^