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Environmental Health Department <br />i <br />2. <br />Name of orgamzalion/busmess <br />BlocktonAddress. <br />Phone <br />3 <br />4 <br />5. <br />6. <br />9 <br />meats, tamales, cooked beans, rice, <br />)__________7-------------------- <br />fnfiA Chichi gk^Ajer <br />7 <br />8. <br />Liik? <br />SANJOAOUIN <br />COUNTY <br />G/roli>r*» qicwv fv •• <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />") are required to return a signed and completed copy of this checklist Io <br />the festival coordinator three (3) weeks prior to this event <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 />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source <br /> Other (specify): ----------------------------———— ------------------------- -----------------------------------------------— <br />Electricity is provided for my booth's use U Yes [/J 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 0Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove Sterno & hotel trays <br />IZfDouble steamer [zfSteam table & lids <br /> Electric stove top Other (specify) <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton. California S5205 | T 209 468-3420 I F 209 464-0138 | www.S|Cehd.cOT <br />EHD 16-07 P»fle7o<11 <br />07/3/17 <br />Date(s) _? <br />All food vendors (both for profit and non-profit) <br />'t Name of Event ^20^6012^^ <br />The following is information about my orgamzation/busmess <br />34^ HcttiYlOlcj-14/''I Qt__i <br />C'?0C(] Cp/Q?" 2^? 2-_________ Alternate ( <br />List fgod to be sold or giveq to the public: <br />ncc . rried <br />I am providing food that is NOT prepared at home Lj Yes LJ no <br />All food is prepared on-site or is from approved commercial facilities. EfYes No <br />Nameo.fadl.ty: ~ <br />Address of flintyI 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 ^^h 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 />pother (specify) ----------------- <br />Note: The only operations not required to provide enclosed booths