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0 <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />fr3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />-COUNTY - <br />Date(s)/oTZ<2 C’ <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 APP <br />06/19/19 <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 />[^Approved bottled water. <br />Ej On-site hose bib that is connected to a potable water source. <br /> Other (specify):________________________________________________________ <br />Electricity is provided for my booth’s use: O'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: H Yes 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 Stemo & hotel trays <br />[^Tbouble steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 prior to this event r <br />1. Name of Event: S/’QC/-A?1 <br />The following is information about my organization/business: „ <br />Name of organization/business: ft// <br />Address: 3^/.CZ? f <br />Phone: (C/^). - 2 I Alternate: ( ^/^ !7 <br />List food to be sold or given to the public: / <br />I am providing food that is NOT prepared at home: |0Yes No <br />All food is prepared ornsite or is from approved commercial facilities: Yes No <br />Name of facility: Phone: ($J? <br />Address of facility7^EZ_Cl^^ <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 />□ZA 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 /> Other (specify):