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Environmental Health Depart.: nt <br />Sept 14th S 15th, 2024Date(s):I.Name of Event:1. <br />The following is information about my organization/business:2. <br />Address: <br />607-7308209) Alternate: (Phone: <br />Tri-Tip and Linguica sandwichesList food to be sold or given to the public:3. <br />4. <br />835-4590 <br />5. <br />6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />s <br />e9. <br />meats, tamales, cooked bei... <br /> Other (specify): - — <br />Note: The only operations not required to provide enclosed booths are those which sell beverages 1. m <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following me^ <br />7. <br />8. <br />d <br />7 APR <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgczc <br />EHD 16-02 Page 7of 11 TEMPE.L <br />07/01/2024 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />St. Bernards Parish Fall Festival <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: E Yes No <br />Name of facility: st- Bernard's church Phone: (209 ) <br />Address of facility: 163 w- Eaton Ave~ Tracy Ca 95376 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from -s, <br />dust and the public) <br />( 209 <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 prepare- 'n <br />areas from the public. <br />SAN JOAQUIN <br />COUNTY------ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />) 835-4560 <br /> Other (specify):_ <br />Electricity is provided for my booth's use: L3 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially h"7 <br />foods during all times of booth operation: E Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />135°F: <br /> Camp stove Sterno & hotel trays <br />O Double steamer LJ Steam table & lids <br /> Electric stove top Other (specify) <br />Name of organization/business: st. Bernard's Parish Fall Festival <br />163 w. Eaton Ave. Tracy Ca 95376