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Environmental Health Department <br />Date(s): 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SANJOAQUIN <br />------COUNTY------ <br />Greotriess yroivs here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />r .fo bs v^|S)cU-S <br />liiki <br />^ves No <br />Phone: {1 <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 />'^'Approved bottled water. <br />v^On-site hose bib that is connected to a potable water source. <br /> Other (specify):---------------------------- ---------------------------------------------------------------------— <br />Electricity is provided for my booth's use: Dy-Yes U No . <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:'QA'es No <br />I am providing the following hot temperatufe control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer ^3-^team table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Paa0 7 °r 11 TEMP EVEN1 APP <br />07/3/17 <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. , III <br />1. Name of Event: fijSlQC) .9 I C FjSAi \//Aj . Date(s): <br />The following is information about my organizption/business: . <br />Name of organization/business: pAnmX Srwk <br />f-I^A Ln. Loc^\ i Ch <br /> Alternate: ( ) <br />List food to be sold or given to the public: H ~ K) O tk I <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: <br />Name of facility: OA S) vC- OV__QjZ. <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 /> 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 piepaiation <br />areas from the public. C\ t \ x 1 <br />p other (specify): m HAVf our aW -------- <br />Note: The only operations not required to provide enclosed booths