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Environmental Health Department 1. 2. <751 Address: 3. 4. 5. 6. 9. meats, tamales, cooked beans, rice, /_____ 7. 8. Alternate: ( A ! /O // the hot and cold holding of potentially hazardous control for the hot holding of all potentially hazardous foods above Camp stove ^Sterno & hotel trays Double steamer O Steam table & lids Q Electric stove top O Other (specify) of potentially hazardous food include: All food vendors (both for profit and non-profit) are required to return a f'TsI" Date(s): plastic, similar material and fine mesh fly smooth and cleanable floor (concrete, to separate food and food preparation SAN JO AOUIN 2 ' ------COUNT Y------ Grcotness grows here. TEMPORARY FOOD VENDOR’S APPLICATION signed and completed copy of this checklist to Note: Examples c. r . vegetables, potato salad, eggs, and dairy products. )—- Other (specify):---------- -------------------- ---——=—--------- Electricity is provided for my booth’s use: [23, Yes |_J No 1 am providing an accurate probe thermometer to measure foods during all times of booth operation: H-'Yes |_J No I am providing the following hot temperature c-------- the festival coordinator three (3) weeks prior to this event. 1. Name of Event: S V,__/] H/rV tS--------------------1 The following is information about my organization/business. Name of organization/business:-^71— 'P ------ Phone: List food to be sold or given to the public:. 1 am providing food that is NOT prepared at home: SfYes No /Ml food is prepared on-site or is from approved commercial facilities: Yes No Phone: ( ) ________Name of facility: ____ “tooth with the following: (to proleci my unpackaged food and (ood-preparatlon areas from fcs. dust and the public) A booth with walls and ceiling constructed of either wood canvas, screening, completely enclosing open food areas. It will also have a asphalt, clean tarps and smooth wood are acceptable) and constructed areas from the public. 'p3 t i'L' 'TT--------------- required to provide enclosed booths are ^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. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: (^Approved bottled water. On-site hose bib that is connected to a potable water source. 1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420, F 209 464-0138 | www.sjcehd.com EHD 16-02 Page 7 of 11 07/3/17