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Environmental Health Department <br />1. Name of Event: 1.. J- _ <br />2. <br />1 <br />Address: <br />5Phone: <br />3. <br />4. <br />5. <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <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 />SAN JOAQUIN <br />— COUNTY------ <br />C.ifn< xc i). iu’i. . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVEN! <br />07/3/17 <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 (3J woatc nrinr rn this evant <br /> Other (specify): — <br />Electricity is provided for my booth's use: EYes 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: ffYes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />13^F: <br />nO'Camp stove Sterno & hotel trays <br />©-Efouble steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Alternate: ( ) --------------------------------- . <br />'ft- <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: &Ves EJ No <br />Name of facility:------- <br />Address of facility: *70 9 f~ --------------------------------- <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 />[jJ'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 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 />The following is information about my organization/business: <br />Name of organization/business: ' S <br />(Z0C!y 365^65<77_____ <br />List food to be sold or given to the public: / ,