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Environmental Health Department <br />All food vendors (both for profit and non-profit) <br />1. <br />2. <br />Address: <br />)Alternate: (Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Other (specify):. .—— --------------------------------------—- <br />Note: The only operations not required to provide enclosed booths <br />Date(s): /1 I <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pago 7 of 11 <br />07/3/17 <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 />^On-site hose bib that is connected to a potable water source. <br /> Other (specify):___ __—------------------- ----------------------------------------------------------- <br />^amtrpCroviding°an accurate probe tamomrter to measure the hot and cold holding of potentially hazardous <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br />pother (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: 'gj^es No <br />I am | <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SAN.JOAOUIN <br />------COUNTY— <br />Greoh'icis grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-) 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 /> ( AlA'V <br />- o .tr. V-L1 <br />. ..-x< <br />1.Name of Event: (. AtMbj -p4.L£ <br />The following is information about my organization/business: <br />Name of organization/business: ------\ A 1 ----------- <br />7 11| me n A Avc^______ <br /> <br />( ^(■ •^ ) 6 • A’Vo A --------- <br />List food to be sold or given to the public:. <br />I am providing food that is NOT prepared at home: IZ^Yes O No <br />All food is prepared on-site or is from approved commercial facilities:^Yes No <br /> Name of facility:phone:<-------*-------------------------------------- <br /> <br />fam providinga^ooth with the following: (to protect my unpackaged food and food-preparation areas from flies? <br />dust and the public) <br />RU booth with walls and ceiling constructed of either wood canvas, plastic, similar matenal ancI fine mesh fly <br />screeninq completely enclosing open food areas. It will also have a smooth and cleanable floor (conc^te, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparat <br />areas from the public.