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I <br />3. <br />4. <br />5. <br />9. <br />( <br />[ ] Electric stove top <br />[ J Other (specify): <br />[ ]No <br />the hot and cold holding of potentially hazardous <br />[ JNo <br /><^77!Je <br />( JNo <br />I ]No <br />Date(s). 5 Cp <br /> <br />SAN JOAQUIN COUNTY <br />enviormental health department <br />1868 East Hazelton Avenue, Stockton, California 95205 <br /> Business: (209)468-3420 <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />AH food vendors (both for profit and non-profit) u.. .^u;, ,c,ul „ <br />checklist to the festival coordinator three (S^weeks prior to this event. <br />1. Name of Event: <br />2. <br />P(1 Yes <br />• measure <br />Yes <br />control for the hot holding of all potentially hazardous foods <br />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 />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br />List fc<^°be sold orgiven to the PubIic: _ZZ^^s <br />--------1 A? 5^ ._________/t/g-Xi. ' <br />I am providing food tha/is NOT prepared~at home: Yes <br />All food is preparedortsite orjs from approved commercial facilities: M Yes <br />Name of facility: j QtrCf Phone- <br />Address of facilityZJ^^^g^ C4 ^5J^7 -------- <br />am providing a booth with the following: (to protect my unpackaged food and food preparation areas from <br />flies, dust and the public) <br />C^] A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mesh fly screentng, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ J Other (specify): _____________ <br />Note: <br />methods: <br />M Approved bottled water. <br />I ] On-site hose bib that is connected to a potable water source. <br />[ ] Other (specify): <br />7. Electricity is provided for my booth's use: | <br />8. I am providing an accurate probe thermometer to <br />foods during all time of booth operation: <br />I am providing the following hot temperature <br />above 135 degrees Fahrenheit: <br />[ ] Camp Stove Double steamer <br />!X] Stemo & hotel trays [ ] Steam table & lids <br />are required to return a signed and completed copy of this <br />The following is information about my organization/business: <br />Name oforganization/business:77^4 i A <br />Address: _Z1 7/ <br /> Altema^ <br />Afeta/ _i_CketSC'