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Environmental Health Department <br />Market on Maple1. Name of Event .1. <br />2. <br />Address: <br />- H 3 5 PbonR <br />3. <br />4. <br />5. <br />/i/MFT Other (specify)/ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />9. <br />meats, tamaJes, cooked beans, rice, <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 />7. <br />8. <br />1868 E. Hazelton Avenue) Stockton. California952051 T 209 468-3420) F 209 464-0138 ) www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br />O On-site hose tofo that is connected to a potable water source. <br /> Other (specify _____________________________________________ <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />ZTYesO No <br />Phone. <br />Q Stemo & bote/ trays <br /> Steam table & lids <br /> Other (specify) <br />Name of organization/business: <br />\~7 ro <br />The following is information about my organization/business: <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 fes&wal coord^ator &irae (3) weefcprtorto thts avent Satu rdays <br />May-Oct <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 tfte ptAtic. <br />foods during ail times of booth operation: Yes Q No <br />f am providing the trflowing hot temperature control for the hot holding of aS poCenStaSy hsadous foods above <br />IS&F: <br />EJ Camp stove <br />O Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br /> <br />. f-r Qi <br />Aftemate ( T <br />I am providing food that is NOT prepared at home: Yes QT^o <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of tarfflty: rv-y S Phone. (%5~S~) <br />Address of faciBty- .-PP P3/? • C-f <br />I am providing a booth vwth the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />> SAN JOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />List food to be sold or given to the public: prT^- <