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Environmei.ial Health Department 1. Name of Event: S-C A-1. 2. Address: Alternate: () Phone: List food to be sold or given to the public: 3. 4. 5. Other (specify): 6. 9. pCD v" A 'P& q meats, tamales, cooked beans, rice, r l i Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 7. 8. The following is information about my organization/business: |3) cr-j-_____4zAr^ Ia4z5v) , 'A 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com EHD 16-02 Page 7 of 11 TEMP EVENT APP 07/3/17 Yes'SZpNo om^ter fo measure the hot and cold holding of potentially hazardous Yes 0 No Name of organization/business: Urvu 'Qf i gy) (l ST Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ■^Approved bottled water. /□ On-site hose bib that is connected to a potable water source. Sterno & hotel trays Steam table & lids Other (specify) pC£) Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Other (specify): Electricity is provided for my booth’s use: 0 I am providing an accurate probe thermomefe foods during all times of booth operation:^ '' I am providing the following hot temperatu/econtrol for the hot holding of all potentially hazardous foods above 135°F: Camp stove Double steamer Electric stove top * - i ■ LiUAA . , All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. ( S t Date(s): g' -s -iq C'^1 ^,-£4 t I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: Yes No Name of facility: .Xp Phone: ( ) Address of facility: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) "0^A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly /screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. SANJOAQu.N ------COUNTY------ Greatness a tons here TEMPORARY FOOD VENDOR’S APPLICATION 3 SGI