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Environmental Health Department <br />Date(s): /71. <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />c >4. <br />5. <br /> Other (specify): <br />6. <br />EhOn-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />3'Approved bottled water. <br /> Other (specify):___ ________ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <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 />SAN.JOAUUIN <br />------COUNTY------ <br />h tC\ <br />5 A Zc)x7 1 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of ail potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />i^O S pc <br />I am providing food that is NOT prepared at home: Yes lUh'Nb <br />All food is prepared on-site or is from approved commercial facilities: Yes B-No <br />Name of facility: /AAlIlK Lt/f /b Phone: ( 77T/\ - 1' ) 7^7 <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 />Alternate: ( )_________________ <br />'■ • ' jo <br />The following is information about my organization/business: <br />A a <br />Name of organization/business: 7 A-/ fZ/bA <br />J.ilPn/il- sb <br /> <br />/) ' cos <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: <br />. 70^ <br />7 :' t a M <br />\ / <br /> Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION