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Environmental Health Department <br />i.Date(s): <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />Other (specify): <br />those which sell beverages from <br />6. <br />On-site hose bib that is connected to a potable water source <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />10. <br />TEMP EVENT APPPage 7 of 15 <br />The following is information about my organization/business: <br />Name of organization/business: Noor Tiffin Service <br />8065 Shay Cir, Stockton. CA, 95212 <br />(209)395-5321 <br />7. <br />8 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />Alternate: (916)831-0977 <br />List food to be sold or given to the public: Pani-Puri , BheLPuri, Chole- Kulche <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources <br />Stemo & hotel trays <br />Steam table & lids <br />Other (specify) <br />Note: Examples of potentially hazardous food include: <br />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 />EHD w 02 Hazelton Avenue I stockton, California 95205 I T 209 468-3420] F 209 464-0138 | www.sjgovorg/ehd <br />06/19/19 Page 7 of 15 <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 Name of Event: Durqa Puja 2022 <br />I am providing food that is NOT prepared at home: Yes Ng <br />All food is prepared on-site or is from approved commercial facilities. Yes Ng <br />Name of facility: _ ____________________________Phone: <) f / <br />Address of facility: <br />* ^^'and foe public)1 followin9; Protect unpackaged food and food-preparation areas from flies, <br />A boofo 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 />asPhafr^clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />SANJOAOUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Other (specify): <br />Electricity is provided for my booth’s use: Yes Ng <br />I am providing an accurate probe thermometer to measure foe hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />' foUow'GS hot temperature control for foe hot holding of all potentially hazardous foods above <br />Gamp stove <br />Double steamer <br />Electric stove top