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Environmental Health Department <br />Sept 28, 2019Date(s):1.1. Name of Event <br />2. <br />Address: <br />209-239-1588()Phone: <br />List food to be sold or given to the public:3. <br />4. <br />209-239-1588 <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />KI Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APR <br />7. <br />8. <br />The following is information about my organization/business: <br />The Cajun Spot, LLC <br />£3 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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <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 />Name of organization/business: <br />283 W Louise Ave Manteca, Ca 95336 <br />Q Stemo & hotel trays <br /> Steam table & fids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 festival coordinator three (3) weeks prior to this event. <br />Red White & Brew <br />foods during all times of booth operation: £3 Yes No <br />I am providing the following hot temperature control for the hot holding of ail potentially hazardous foods above <br />135T: <br />Q Camp stove <br />|X] Double steamer <br /> Electric stove top <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Rags 7 of 11 T”.T " <br />07/3M7 <br />_________ Alternate: ( ) <br />French Fries, Chicken Tenders <br /> Other (specify):_______________________________ ____ <br />Electricity is provided for my booth's use: Yes KI No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />I am providing food that is NOT prepared at home: K3 Yes No <br />All food is prepared on-site or is from approved commercial facilities: KI Yes No <br />Name of facility: The Cajun Spot Phone: (____1 <br />Address of facility: 283 w Louise Ave Manteca, Ca 95336 <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 />; v SANJOAQUIN <br />' ------COUNTY------- <br />1 ca-'1’ Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION