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Environmental Health Department <br />2. <br />Name of organlzation/business: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />mettle, tamales, cooked beans, rice, <br />7. <br />8. <br />id ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />1 areas. It will also have a smooth and cleanabie floor (concrete, <br />acceptable) and constructed to separate food and food preparation <br />209 464-0138 | WWW.sjcehd.com1868 E. Hazelton Avenue | Stockton, California 96206 | T 209 468-3420 | F <br />EHD IB-02 PsO^Zofll <br />07/3/17 <br />I i <br />’ A'"'’ <br />The following is information about my orgamzation/business^ <br />Name oforganization/business: /L-j-L <br /> <br />Address: ^3? 7 .zU-^^/QO^ / <br /> ( ) ~ "7 / 7C/-____ Alternate: ( )' ------------------------- ---------- <br /> <br />List food to be sold or given to the public: <br /> Other (specify):------------------- ----------------------—---------------- ------------------------------- - ' <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 />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />ElectricityVsPprovided for my booth’s use: □ YesJJ No <br />I arn providing an accurate probe thermometer to measure <br />! mlX" hot hotdino of all potantWIy hazardous foods above <br />135‘‘F’ <br /> Camp stove Sterno & hotel Irays <br /> Double steamer t IZJ Steam table & lids <br /> Electric stove top Other (specify) <br />Noto: Examples of potentially hazardous food Include; <br />vegetables, potato salad, eggs, and dally products. <br />SAN JOAQUIN <br />■ Jl — COUN I Y- <br />(..fCflhlC'S i/KHVS ll'-l < . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I am providing food that is NOT prepared at home?j^ Yes No <br />All food is prepared on-site or is from approved cornmercial facilities:Yes No ~ qQ <br />Name of facility: Phone: ---------- <br /> <br />dust and the public) <br />V] A booth with walls am <br />'screening, completely enclosing open food <br />asphalt, clean tarps and smooth wood are i <br />areas from the public. <br />All food vendors (both far profit and non-profit) are required Io return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this evmil. / -/ / / /7 / <br />1 1.Name of Event:( r-/3'-<< X__7 Date(s):<>57,/ .6^/^~7 <br />The following is information about my organj^ation/buslness^ <br />iaM&PYW.__________