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Environmental Health Department <br />Date(s)1. Name of Event1. <br />2. <br />Name of organization/business: Little Beez Italian Ice <br />1358 Mirassou Dr Manteca Ca 95337Address: <br />) 813-1279Alternate: (sioPhone: <br />3. <br />4. <br />5. <br />( <br />6. <br />TEMP EVENT APRPage 7 of 11 <br />7. <br />8. <br />9. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />SAN JOAQUIN <br />------COUNTY------- <br />(.yccotness gror^s here- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />(510 ) 813-1279 <br />List food to be sold or given to the public: frozen fruit dessert Italian ice , bottled watery <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov orgfehd <br />EHD 16-02 Page 7 of 11 <br />07/01/2024 <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 /> <br />The following is information about my organization/business: <br />I am providing food that is NOT prepared at home:0 Yes No <br />All food is prepared on-site or is from approved commercial facilities^ Yes No <br />Name of facility: Phone: (866 )t52-9l86---------------------------- <br /> fam providing a^ooth with the following: (to protect my unpackaged food and food-preparation areas from flies' <br />dust and the public) <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 deanabie 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 /> f-y-j Other (specify): se|f contained cart_____________________________________________________________— <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Q Other (specify): wash station set up ______ ________________ <br />E lamp^S^id^a^lccuX0^ the hot and cold holding of potentially hazardous <br />I Jnfproviding thVfXwbg hot temperaturPcontrol for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp st ove Stemo & hotel trays Steam table & lids <br /> Double steamer Other (specify) <br /> Electric stove top H <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.