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Environmental Health Department <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />CA <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />0 Approved bottled water. <br />J/fOn-site hose bib that is connected to a potable water source. <br /> Other (specify):----------------- ---------------------------------------------------- — <br />Note: The only operations not required to provide enclosed booths <br />SANJOAQUIN <br />---------COUNTY------- <br />Greatness c/rows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />signed and completed copy of this checklist to <br />natefel: \4, N <br />2234 <br />List food to be sold or given to the public:. <br />AZgaZ Date(s): 6o\ <br />the festival coordinator three (3) weeks prior to this event. <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 B Hazelton Avenue | Stockton, California 95205^1 T, 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 <br />All food vendors (both for profit and non-profit) are required to return a <br /> Other (specify):_ --- --------- <br />Electricity is provided for my booth’s use: Ed Yes LI No <br />I am providing an accurate probe thermometer, to measure <br />I amproX9 the Xfng'o^em'eX^ntro! foHhe hot holding of all potentially hazardous foods above <br />PfCamp stove O Sterno & hotel trays <br /> Double steamer D Steam table & lids <br /> Electric stove top Q Other (specify) <br />Note: Examples of potentially hazardous food include. <br />-LYN-;-- <br />I.Name of Event: <br />The following is information about my organization/business. <br />Name of organization/business: --------------------- <br />___TSVocUrOO. <br /> Alternate: ( <br />_________ <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: [3'Yes No <br />Name of facility: Phone: (^H) <br />Address of facility: ~~| ?> I /AaaC----------- <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 />□^booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine imesh fly <br />screeninq 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.