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Environmental Health Department <br />Dale(s): 1. <br />The loikj.ving s tnlormabon about my organizabon/busness:2. <br />Name ol organizaton/busmess: <br />Address: <br />315-4062 ) Alternate. (( 408 )Phone: <br />List food to be sokt or given Io the pubic:3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />Q On-site hose brb that s connected to a polabte water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />Note: Ttie only operations not required to provide erckiseJ booths are those whch seB beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wasv.sjcehd.com <br />B-iD16.O2 Piqp’crU TEN'P AFP <br />07/317 <br />Approved water for drinking, utensil and hand washing w»fl be provided in my booth by the lolfoawig metoods: <br />^^(pproved bottled waler. <br />8. <br />Q Sier no & hotel trays <br /> Steam table & ids <br />Fj^dfier (specify) <br />SAN JOAQUIN <br />— COUNTY— <br />Greatness groivs here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />071 booth wrlh watte and ceiling constructed of erlfier wood, canvas, plastic, similar material and fine mesh hy <br />screening, completely enclosing open food areas. It wifi ateo have a smooth and cteanable hoar (concrete, <br />asphalt clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the pubic. <br />Note: Examples of potentially hazardous food inctude: <br />vegetables, potato salad, eggs, and dairy products. <br />O Other (specify): ._______________________________________________ <br />Etectrertyrs provided for my booth's use: r~lYes <br />I am providing an accurate probe thermomete^lo measure lire hot and cold holding of potentially hazardous <br />foods during al! times ol booth op era ton: gres Q Nu <br />I am providing the following hot temperature control tar the hot holding of ail potentially hazardous foods above <br />135*F: <br />QCamp stove <br />("I Double steamer <br /> Electric stove tap <br />GF AF Bakery <br />1559 W. Monterey Ave. <br />Ah food vendors (both for profit and non-profit) are required to return a signed and completed copy of thrs checklist to <br />the festival coordinator three (3) weeks prior to tins event <br />l.Nameol Event Stockmarket <br />Baked goods <br />I am providing load that is NOT prepared at home: Q Yes S^o <br />All food rs prepared on-site or rs from approved commercial facdties: Q No <br />Name of lacrtrty. ^F Bakery Phone. ( <br />XWdress of facrlty:1559 W. Monterey Ave_______________________ <br />I am providing a booth with 6re Mowing: (to protect my unpackaged food and to cd-prepara bon areas from hies, <br />dust and the pubic)