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Phone: () Alternate: () 209-430-6900 <br />3. List food to be sold or given to the publicx Hot Dogs, Chips, Soda <br />Other (specify): Hot Dog cart <br />6. Approved water for drinking, utensil and hand washing will 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 />Environmental Health Department <br />OR <br />4. I am providing food that is NOT prepared at home: Yes <br />All food is prepared on-site or is from approved commercial facilities: Yes <br />Name of facility: Phone: () <br />Address of facility: <br />5. 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 />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 />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <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 />Other (specify): <br />7. Electricity is provided for my booth’s use: No <br />8.1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Camp stove Sterno & hotel trays <br />x Double steamer Steam table & lids <br />Electric stove top Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd ehd <br />SANJOAQUIN <br />COUNTY <br />11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />x Ice chests Refrigerator <br />Refrigerated truck Ice bath and tubs <br />Other (specify)