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<br />V* <br />Environmental Health Department <br />I.Name of Event:1. <br />2. <br />Address: <br />Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />5. <br />40 <br />6. <br />9. <br />£D CamScanncr <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />® Other (specify): krf/6 <br />- <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: Yes No <br />Name of facility:Phone: (1 <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) <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 7 ol 11 TEMP EVENT APR <br />07/01/2024 <br />® Other (specify): W ^6- * <br />Electricity is provided for my booth's use: £2 Yes No ’HomJI ' <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />r^135°F: <br />JS Camp stoves: <br /> Double steamer <br /> Electric stove top <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 />WOtheT(sr^dfyX (aJ f(ISVcA • <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 />The following is information about my organization/business: <br />Name of organization/business: <br />Vi/ /2-eZ <br />) ^^4 - ^7/0 ___ Alternate: <br />j ”7^, <br />SANJOAQUIN <br />■ « . ------COUNTY------- <br />Greotncss grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />(X Sterno & hotel trays <br /> Steam table & lids <br />Other (specify) • <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <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 />-H/tZzL, frQdAaAg. ■ Date(s):