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Environmental Health Department( <br />2: <br />Alternate: ( <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />nr \ // <br />1868 E. Hazelion Avenue | Stockton, California 95205 | T 209 468-34201 F 209.464-0138 | www.sjcebd.qom <br />EHD 16-02 Pago 7 of 11 <br />P7/3/17. <br />SANJOAOUIN <br />------COUNTY'------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />Approved water for drinking, utensil and hand washing will be provided In my booth by the following .methods: <br />pfl Approved bottled water. <br /> On-site hose bib that is connected to a potable.water source. <br />O Other (specify): --------------------------------------------------------------------------------------------------------—-------- <br />Electricity is provided for my booth’s use: UYes^K No <br />1 am providing an accurate probe thermometer to nieasufe ’the hot and cold holding of potentially hazardous <br />foods during all times of booth operation^ KI Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />435°F: _ <br /> Gamp stove Q Sterno & hotel frays <br />[7] Double stoamer Fl SJestfri table & lids <br /> Electric stove top -B’Oiher (specify) f <br />Note: Examples of potentially hazardous food Include: meats, tamales, goqked beans; rice, <br />' vegetables, potato salpd, eggs, arid dairy products. <br />All food vendors (both for profit arid non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event f . <br /> <br />1. 1. Name of Event: ----------------------Date(s):-; ^^^2^ 1^1 <br />The following is information about my organizatibn/buslness: <br />Name of organization/buslness: A T <br />Address: zg £-<?(/; At/e- ZoY/ <br />Phone: ■ $________ ______ <br />List food to be sold or given to the public: J <br />I ahi providing food that is NOT prepared at homo:^ Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes LI No <br />Name of facility: 6'X (V f I IZ Phone: .(Cgfl. ------------ <br />Address of facility: bac/} — <br />I am providing a booth with the following: (to protect my unpackaged food arid food-preparation areas from flies, <br />dilst and the public) <br /> A booth with walls and ceiling constructed of either' wood, canvas, plastic, similar material and tine mesh fly <br />screening, coihpletely 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 preparalion <br />areas from the publiq. <br /> Other (specify):___ ____________________ <br />Note: The only operations not required to provide enclosed booths