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Environmental Health Department <br />I.Name of Event: Date(s): 1. <br />2. <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />ier (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <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 />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 />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />EjStemo & hotel trays <br /> Steam table & lids <br />Dither (specify) <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greatness grov/j here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />(□Other (specify):( ___________________________________________ <br />Electricity Is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometeptb measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Q^res No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 | www.sjgov.org/ehd <br />EHO 16-02 P»g«7of11 TEMP EVENT APP <br />06^42023 <br />i: E^es No <br />Phone: (___1 <br />The following is information about my oraanization/buslness: <br />Na™ of ^anlzation^ness: <br />Address: A ■ Gl/tiT) WF- 04- 7(57^^ <br /> <br />■77^00 7^^ - -fTMtj 7*^, TTXEr <br />----------—------------------—------------------------ <br />I am providing food that is NOT prepared at home: [R^esD No <br />All food is prepared on-site or isfrgm approved commercial facilities: <br /> Name of facility. ^,77 <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)