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Environmental Health Department <br />1.Date(s): /X,/7 // <br />2. <br />Phone: <br />3. <br />Xi <br />4. <br />5. <br />..f <br />6. <br />i Vn/cV <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />return a signed and completed copy of this checklist to <br />EHD?M2 HaZeltOn A'/er,ue < '-etockton Californ'a 95205 I T 209 468-3420 I F 209 464-0138 | www.sjgov.org/ehd <br />06/19/19 Page 7 of 11 TEMP EVENT APP <br />SAN JOAQUIN <br />COUNTY <br />Greatneis Jrows 'h--, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: S <br />The following is information about my organization/business: <br />Name of organization/business: <br />Ad(lress: -fen . ca ^,0 <br />-----------------------------Alternate: (7^ <br />List food to be sold or given to the public: , <br />I am providing food that is NOJ prepared at home: p Yes No <br />All food is prepared Oh-site or is from approved commercial facilities: E Yes No <br />Name of facility; lYVlkllftn Phone: (<1IU ) b -1 7 H <br />Address of facility:. J z <br />' XTand the^bTc?'he ,Qll0Wlr® (l° pr°'ec, my unPactagedfood andSod-preparation areas from flies. <br /> A booth with walte and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />SXTda^ taP™eXrdn 'Ih °Pea foOd areas' " Wi" alS° have a Smooth and cteanable floor (concrete <br />areas fromTe pub^c aCCeptable) and “^cted to separate food and food preparation <br />P O^er (specify): ' " fyl|^ . <br />Note: Innr^d X™*'0"5 n0' reqi,ir1ed lo Provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. y <br />Approved water for taking, utensil and hand washing will be prov!ded in my booth by the following methods: <br /> Approved bottled water. <br /> On-site hpse bib that is connected to a potable water source. <br />QOther (specify):' lr\(tv>\ k \ <br />Electncity is provided for my booth's use: Yes 3 No 3 <br />' r HVldin9 probe ,thermomreJer t0 measure the hot and cold holding of potentially hazardous <br />foods dunng all timdS of booth operation: 0 Yes No po^rmdny nazaroous <br />' an? Pr°v,din9 the fonohing hot temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove ! Q Sterno & hotel trays <br /> Double steamer t E steam table & lids <br /> Electric stove topr.. Q other (specify) <br />Note: Examples of' potentiallyl hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.