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Environmental Health Department <br />Market on Maple1. Name of Event:1. <br />2. <br />Dr) IAddress: <br />O'T0 >PbOHK <br />co/il3.. <br />4. <br />5. <br />/!/MF7 Others <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />O Approved bottled water. <br />9. <br />meats, tamaJes, cooked beans, rice, <br />lifting <br />7. <br />8. <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 /> 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 puWc. <br />O Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />ZfYesO No <br />Phone. (^5~S~) <br />The following is information about my organization/business: <br />- H 4. 3 s <br />O On-site hose tffo that is connected to a potable water source. <br /> Other (specify ___________________________________ <br />Electricity is provided for my booth’s use: Q Yes 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: Yes Q No <br />f am providing the toftowtng hot temperature controf for the hot holding ot aS potertiatty hsadous foods above <br />f35^F: <br />EJ Camp stove <br /> Double steamer <br /> Electric stove top <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 fas&va] coordinator Brae (3) weeksprtarto this event Saturdays <br />May-Oct <br />Name of organization/business: ftunnwioer <br />IT? ro <br />Note: Examples of potentially hazardous food include: <br /> veqetwihtes, iWlafo <br />■ .*><^0 (Ct C\c^~o <br />____ MkscoIbk. ( T <br />/•Sat SANJOWttIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420 F 209 464-0138 ) www.sicehd.com <br />EHD 164)2 Page 7 of 11 TEMP EVEHT APP <br />07/3/17 <br />I am providing food that is NOT prepared at home: Yes O'No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of tanfflty: iT~Cc<a/^-x Phonsi (^3~S~) Cp <br />Address of tadlity. . Vo L.t-C cirY'lr a <br />I am providing a booth with the following: (to protect my i^ackaged food and food-preparation areas from flies, <br />dust and the public) <br />List food to be sold or given to the public: VHA-rywntxS^, c