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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />7. <br />8. <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAOUIN <br />------COUNTY------- <br />Greatness grows here, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />9613 Z3EZ5Z <br />fT] 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />approved corpmercial facilities'^^ Yes No <br />Phone: ) Y45 1 <br />I am providing food that is NOT prepared at home?H Yes No <br />All food is prepared on-site or is from — ,, <br />Name of facility: PI <br />Address of facility: PN-Vh" z~~g~T~ <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 />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. • z-s <br />1. Name of Event: SY. tfauM YshA: Date(s): <br />The following is information about my organization/business: . <br />Name of organization/businessYY, A d-Htwiu CoYWic 0 huvCT/t <br />Address: <br />)313^J-3VIT Alternate:) 3 AS 8*0 <br />List food to be sold or given to the publitL-ScC /3l <br /> Other (specify):x________________________________________________________ <br />Electricity is provided for my booth’s use?Q Yes No <br />I am providing an accurate probe therrrfsmeter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation?® Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />Sterno & hotel trays <br /> Steam table & lids <br />^3 Other (specify) / <br />Note: Examples of potentially hazardous food include: meats, tanO^^^oke^^eadQf^^e^ <br />vegetables, potato salad, eggs, and dairy products.