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Environmental Health Department <br />1.1. Name of Event. <br />2 <br />Name of organIzatjonjfcusiness: <br />Phene. <br />3. <br />4. <br />5. <br />o ocher (Sfiecify): <br />6. <br /> On-site hose bi> that is connected to a pctafate water source. <br />9, <br />meats, tamales, cooked beans, nee. <br />TEMP EVENT APPPage 7 of 11 <br />Note: Examples of potentfaBy hazardous food metude: <br />vegetables, potato salad, eggs, and dairy products. <br />7..a. <br /> Stemo & hotel trays <br />Q Steam table & irds <br /> Other (specify) <br />booth with wsife and ceiling constructed of either wood, canvas, plastic, sanrufar material and fine mesh fty <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are aco&ptabie^ and constFjoteo to separate fax: apd food prepanatjan <br />areas fam the pubic. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />appraved dsscensers, or prarackaged foods from approved sources. <br />SAN JOAQUIN <br />-----COUNTY------- <br />Ini 'i ip . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />stove <br />[4>a?jufote steamer <br /> Electric stove top <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the fofiowing methods: <br />®4(pprov«i botBed'xyster. <br />1868 E. HazeXon Avenue I Stockton, Cafifomia S52051 T 208 468-34201 F 209 464-0138 | www.sjeehd.com <br />EHD 16-02 Pafl« 7 of 11 TEMP EVENT <br />■nrn <br />The fofiowing is infamiafion, about my arganizatarfotasress: <br />AU food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festeva! coofofcrator three {3) weeks prior to tfr^ event . <br />At/He It' <br />I am providing food that is NOT prepared at home: Lp^Ves No <br />AS food is prepared on-site or ss from approved commercial fadi^es: O No <br />Name of facility: <br />Moxess of fodfety: ^^Ajj Z"? <<• <br />I am prcmdirig a ix^h wfeh the toSbmrg. (to protect .my jnpackaged food and fooi-pTBparaton areas fror. flies, <br />dust and the public) <br /> Other (specify): _______________________________________________ <br />Etecfrtaity is prided for my booth's use: ©Yes No <br />8 am provid&rg. an accurate probe fibermometo. to measure the hot and cold hotefiog; of petertfiaily’ hazardous, <br />foods during ail times of booth operation: ^res No <br />I am provkfing the fofiewing hot temperature control for the hoi hekfing of aX poteidsaJfy hazardous foods above <br />Address: / <br /> <br />List food to be sofo or given to the puMt /