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Environmental Health Department <br />the <br />Date(s): Saturdays 8:30 to 12:30 <br />1.Z.N; <br />2. <br />msiitioiName of <br />Addressr <br />) 12Phone: <br />3. <br />at le:4. <br />led food and food-preparation areas from flies,Sect5. <br />which sell beverages fromai <br />frillowing methods:byt6. <br />izardous <br />Is above <br />rice,meats, tamales, cooked <br />vegetables, potato salad, eggs, and dairy products. <br />approved dispensers, or prepackaged foods from approved <br />Approved water for drinking, utensil and hand washing will be provii <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): /1- <br />Note: The only operations not required to provide enclosed boot) <br />ammvftri disnensers. or oreoackaoed foods from approved soi <br />8. <br />(both <br />linatpr <br />ibout my organization/business: <br />ss: <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />fm <br />ENT APP <br />plastic, similar material and fine mesh fly <br />ra smooth and cleanable floor (concrete, <br />ted io separate food and food preparation <br />135°F: <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />lexShEvent <br />llowing is ir <br />is is a <br />profit and non-profit) are required to return <br />ee (3) weeks prior to this event <br />River Islands Certified Farmers' Market <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd., <br />EHD 1602 Page 7 or 11 TEMPI <br />07/3/17 ( <br />_________ Alternate: ( <br />,0,5 Cows. . (3 tcrt\iCO5z reXfa-S <br />isEJNo <br />:ial facilities:^” Yes No <br />A________Phone: (_____1 <br /> Other (specify): X / —J------- <br />Electricity is provided for my booth’s use: Yes 0 No 4/ // <br />I am providing an accurate probe thermometer to measure the hot and cold holding/ of pol <br />foods during all times of booth operation: O’ Yes O No ' , <br />I am providing the following hot temperature control for the hot holding of all potentially ha^a <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />her wood, c <br />It will ^rfso <br />ible) and co. <br />(707 ) <br />List food to be sold or givenWhe <br />I am providing food that is/NOT pi <br />All food is prepared on-site or is frdtri approved cc <br />Name of facility: 1^ TTCZ / — <br />Address of facility:—j.——. <br />I am providing a booth with the follbwing: (to prot< <br />dust and the public) / <br />S^A booth with walls and ceiling constructed o( <br />Screening, completely enclosing open food are^ <br />asphalt, dean tarps and smooth wood are accej <br />areas from the public. <br />public: <br />/ / /