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Environmental Health Department 1.I.Name of Event: 2. Name of organization/business: Address: (Phone: 3. 4. 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. 9. meats, tamales, cooked beans, rice, 7. 8. A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. [^Other (specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP 06/19/19 SAN JOAQUIN ------COUNTY------- Greatness grows here TEMPORARY FOOD VENDOR’S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. On-site hose bib that is connected to a potable water source. [3 Other (specify):. Par uh HaJt Electricity is provided for my booth's use: O Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes 0 No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove H Sterno & hotel trays Double steamer Steam table & lids Q Electric stove top /d VOfl Other (specify) Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Patels): The following is information about my organization/business: Epl'scfipal Church of' Sh ___________ /i&D W. Lihcaln Rflad. SfacJd'orj. Cf} _______ ) <413 - ^13 Alternate: () 4^3 '^777 List food to be sold or given to the public: Chips.', bfincjcrsShepfwfc , d&enS I am providing food that is NOT prepared at home: )3 Yes No All food is prepared on-site or is from approved commercial facilities: KJ Yes No Name of facility: ^plSCtiplJ C/klrCh / Sf. Phone: Address of facility: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public)