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« <br />Environmental Health Department <br />the festival coordinator three (3) weeks prior to this event. <br />1.1. Name of Event: * <br />2. <br />Address: <br />756-5898 <br />3. <br />4. <br />N/A <br />5. <br />Brother (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />f^Approved bottled water. <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <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 APR <br />06/19/19 <br />7. <br />8. <br />SANJOAQUIN <br />------COUNTY------- <br />Gr ess grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />® 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 />All food is prepared in the home kitchen of Sweets Von Shel'le at address listed above and pre-packaged. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Phone: ( 209 ) 756-1935 Alternate: ( 209 j <br />Homemade cakes, jumbo cupcakes (including sugar-free and gluten-free), muffins, mini pies, cinnamon rolls, large cookies, mini cobblers, brownies, candied, and <br />List food to be sold or given to the public: caramel apples, flavored popcorn, dipped pretzels, various candies, and more desserts <br />fffiAOn-site hose bib that is connected to a potable water source. <br />^^Other (specify): Not reqiiirftd for prftpackagftd foods <br />Electricity is provided for my booth's use: Yes Q'No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: Sweets Von Shel'le Homemade Desserts <br />3258 Sacramento Drive, Merced, California 95348 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> L> a Iv ( S ). <br />I am providing food that is NOT prepared at home: Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: Yes S^No <br />Name of facility: N/A Phone: (1 <br />Address of facility: N/A <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)