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Environmental Health DepartmentJI* <br />Mb <br />•k <br />Date(s): 1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />P^Yes □ No <br /> Phone: <br />SAN JOAQUIN <br />------COUNTY------ <br />Gm’<iI nr-yiniv< h-si.-. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 I F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 <br />07/3/17 <br />” > are those which sell beverages from <br />sources. <br /> Other (specify):___________—------------ <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No t <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F- <br /> Camp stove Stemo & 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 />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: <br />The following is infonration about my organization/business: I . <br />2 0 •/) <br />Name of organization/business: <br />Address. \_G <br />(ffiX) (3 Alternate:^ <br />List food to be sold or given to the public: "illCQl. <br />I am providing food that is NOT prepared at home: □ Yes [1/no <br />All food is prepared on-site ok is from approved commercial facilities: <br />Name of facility: g/V LOjC-- fed J1 J.---------- <br />Address of facility: <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 /> 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 /> ^Other(specify): ------- <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved ccur: <br />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.