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Environmental Health Department <br />All food vendors (both for profit and non-profit) <br />1. <br />2. <br />Address: <br />) <br />3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes H'No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />I am providing the follqwii <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: The only operations not required to provide enclosed booths are <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 /> Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />the hot and cold holding of potentially hazardous <br />yiijjg hot temPerature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: [^J Yes O No <br />Name of facility: fob? RA Phone: <br />Address of facility: O LgCyie, STfi f <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 />I^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 public. <br />tl t x. , , • . ) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Philippine Tl^ <br />The following is information about my organization/business: <br />Name of organization/business: ZlAr-pjsh Pc-kz 4 <br />tyt&Z- LonZ <br />Phone: Alternate: ( <br />List food to be sold or given to the public: A S <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I WWW sjcehd com <br />or/Jiz64’2 Page 7 or ii temp event app