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Environmental Health Department <br />1. <br />2. <br />Address: <br />) <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />6 <br />the hot and cold holding of potentially hazardous <br />co'ntroLfor'the hot holding of all potentially hazardous foods above <br />7. <br />8. <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Alternate: ( <br />/ <br />All food vendors (both for profit and non-profit) are required to return <br /> Date(s): —££ l? <br />*7^7 yo <br />No <br />___1 <br />Note: Examples c. . <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): ___________ ____——---------- <br />Electricity is provided for my booth's use: (XL Yes U No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: (3 Yes U No <br />I am providing the following hot temperature c--------- - <br />135°F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />of potentially hazardous food include: <br />SANJOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: 'T, Z| ft/A/f'Q----------------------------1 <br />The following is information about my organization/business. <br />Name of organization/business: <br /> <br />(^7 ) 1 <br /> <br />List food to be sold or given to the public:. <br />I am providing food that is NOT prepared at home: STYes No <br />All food is prepared on-site or is from approved commercial facilities: ® Yes <br />v.Phone: (_ <br />Name of facility: <br />“m“oX““L>th the following: (to protect n.y unpaged food and food-preparaSon areas from Dies, <br />dust and the public) <br />meats, tamales, cooked beans, rice, <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | ^jcehd.c^m <br />EHD1&-02 Page 7 of 11 <br />07/3/17 <br />0A booth with walls and ceiling - aiso'a’ve a^So^an" SeTX'p-lc^ete7 <br />«phT^aP!;^ wPood L acceptable) and constructed to separate food and food preparation <br />areas from the public.