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Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return <br />1. <br />2. <br />Address: <br />) <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />/_____ <br />7. <br />8. <br />^•Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Alternate: ( <br />‘rST- Y a <br /> Other (specify): -------------- ------------------------------------------------- " <br />Note: The only operations not required to provide enelosed booths ere 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 /> <br />Bectridtyf prodded for my booth's use:®Yes □ No <br />I am providing an accurate probe thermometer to measure <br />, arrTprovidlng ^Sng“oT^XTuiBo^^ hot ho.dlng of a» potency hazardous feeds above <br />135°F: <br /> Camp stove ^S*Sterno & hotel trays <br /> Double steamer O Steam table & lids <br />QI Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />meats, tamales, cooked beans, rice, <br />f 86S E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 <br />07/3/17 <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: S 'T.Z} ------ <br />The following is information about my organization/business. <br /> Name of organization/business: <br /> <br />List food to be sold or given to the public:. <br />I am providing food that is NOT prepared at home^Yes No <br />All food is prepared on-site or is from approved commercial facilities: IJ^Yes No <br />Name of facility. ______Phone. ( ) <br /> fam^vo^dmg'abooth with the following: (to protect my unpackaged food and food-preparation areas from flies/ <br />dust and the public) <br />Wi booth with wans and ceding constructed of either wood^canva^. pla* similar <br />a^ph^rcie^'tarps^and'srnoolh X"d am acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Date(s): ~ z? <br />SAOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to