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Environmental Health Department/* <br />iis checklist to <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />4 <br />SAN JOAQUIN <br />—county----- <br />1868 E. Hazelton Avenue | <br />EHD 1642 <br />(NVIfi/lft <br />Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjgovxx^ehd <br />Page 7 of 11 temp event app <br /> Other (specify): ---------------------------------—--------------- --—------------------------------------- ----------- -------- <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 /> On-site hose bib that is connected to a potable water source. <br />Q-6ther <br />7. Electricity is provided for mybooth’s use: U Ves No <br />8. 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 No u <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />ISST: > <br />f~] Camp stove CTStemo & hotel trays <br /> Double steamer □Steam table & lids . <br /> Electric stove top Hfother (specify) ^| <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed apd cx>rppleted copy <br />the festival coordinator three (3) weeks prior to this event // , <br />1. 1 • Name fe./I f -----— Da,e<s>: <br />The following is information about my organization/business: <br />Name of organization/business -—-----------— <br />^40 C>^ kwll Wj., ____——- <br /> (5|0 > W |/m________________ Alternate: 2- ---------- <br />List food to be sold or given to the public: Perp-^>VVg7lT|-\S,Vl I l-fTS <br />I am providing food that is NQT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Q^Yes 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 />^Ta 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.