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Environmental Health Department <br />Dat^s):1. Name of Event.1. <br />2. <br />Address: <br />- H 3 5)_AS-2.Phone: <br />3. <br />4. <br />5. <br />/!/z#EL <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />O Approved hotbed water. <br />9. <br />meats, iamaJes, cooked beans, rice, <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 \ 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 />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 />O 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 pt*H»C- <br /> Stemo & hotel trays <br /> Steam table & lids <br />Q Other (specify) <br />Name of organization/business: <br />I7?ro <br />____ Aftemate; ( T <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&val cocydinator lhrae(3) weeksprtortotWs event Thursdays <br />Market on Maple . . . May-Oct <br />O On-site hose bfo that is connected to a potabte v/ater 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 />foods during all times of booth operation: Yes No <br />f am providing the toftowing hot temperature control for the hot hokfcig of aft potenitatty h^adous foods above <br />ISS’F: <br />El Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />Mitefl deby arndpcts <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 />Nameoftacffity: ia-S ________ <br />Address of tacTfry: [T Q poV'i <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 />SANJOAOBIN <br />------COUNTY------ <br />vGreatr.esz grawa here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />List food to be sold or given to the pubftc: V 5 < h?. z> <; <br />Yes O No <br />Phone. & C R- Cp <br />■. ..................