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Environmental Health Department <br />i. <br />2.The following is information about my organization/business: <br />Serious Seafood - Central ValleyName of organization/business: <br />6333 Paafic Av 105 Stockton CA 95207Address: <br />Phone:( 310 ) 929 - 7100 <br />Seafood (Fried Fish and Fried Shrimp). Chicken Tenders . and Fries3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />H Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />H 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 />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 /> Stemo & hotel trays <br /> Steam table & lids <br />0 Other (specify) Fryers <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): ____________________________________________________ <br />Electncity is provided for my booth s use: E Yes 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: 0 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 />0 Camp stove <br />0 Double steamer <br />0 Electric stove top <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greotness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility:Phone: ( ) <br />Address of facility: <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 />Date(s): <br />Alternate: ( 323 ) 795 - 3042 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks poor to this event. <br />f.Name of Event: LoatedvuvV Siyv^ua. ,| 6i~rL