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I.Name of Event:1. 2. ) Phone: 3. 4. 5. 6. the hot and cold holding of potentially hazardous * meats, tamales, cooked beans, rice, TEMP EVENT APR1868 E. Hazelton Avenue I Stockton EHD 16-02 ’ 06/29/2023 ier top Sterno & hotel trays Steam table & lids Other (specify) Alternate: ( (^2) co . UHIVrJUHWUlll ................................... ------COUNTY------- Gr<ic;lnes5 yrijvs hers. TEMPORARY FOOD VENDOR’S APPLICATION California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd 1 Page 7 of 11 TEMP EVENT Al ■\k) of potentially hazardous food include: 7. 8. 9^ Note: Exampfes vegetables, potato salad, eggs, and dairy products. 4 Yes KI No t ometer forneasure foods during all times of booth operation: Yes [^No I am i 135T: Camp stove-- Doutjfe^J&E ElectBS^sto1 Other (specify):___ Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. ^.Approved bottled water. 0n-site hose bib that is connected to a potable water source. Date(s): ^[zi- Name of organizatjon/busine^s: All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. KIVER ISLAN&S CJFY________ The following is information about my organization/business: L & (*0 o List food to be sold or given to the public: v>c --------------------- I am providing food that is NOT prepared at home: Yes jT^No All food is prepared on-site or is from approved commercial facilities: O Yes EkNo Name of facility:____________________:-----------Phone: (--------)---------------------------------— Address of facility: ::— I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) QA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify):________ Electricity is provided for my booth’s use: P I am providing an accurate probe thermometer providing the following hot temperature control for the hot holding of all potentially hazardous foods above A// Address: 2p \ > H ?