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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greefnrsc qrows here. <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 checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1-Name of Event: (2 hr cV\ 2o2 S <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sigov.org/ehd <br />os^oas Page 7 of 11 TEMP EVENT APP <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 />Q On-site hose bib that is connected to a potable water source. <br /> Other (specify): _ __________ <br />Electricity is provided for my booth’s use: El 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: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove Efstemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top other (specify) <br />Note; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: St / CR <br /> <br />Phone: (7oh ) 76^0Z-^ Alternate; () <------------------------------- <br />List food to be sold or given to the public:^ I —‘h F/ f <br />I am providing food that is NOT prepared at home: Yes £3 No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: ________________________Phone: <br />Address of facility:.__ ____________________ * island the pub|Ot)h followin9: (t0 protect my unPacka9ed food and food-preparation areas from flies, <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 cteanable 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):