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Environmental Health Department icklist to iate(s):1. Name of Event:1. 2. Address: 3. 4. Yes No 5. Other (specify): 6. 9. meats, tamales, cooked beans, rice, 7. 8. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP 06/19/19 SAN JOAQUIN ------COUNTY------- Greatnest grows here TEMPORARY FOOD VENDOR’S APPLICATION Stemo & hotel trays Steam table & lids Other (specify) Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing food that is NOT prepared at home: All food is prepared on-site or is from approved cor/m'ercial facilities: Name of facility: 4 f/) C lu' V H TCK , ■ __________-____ Address of facility:' 11 p N '^'l - I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly sdreening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. All food vendors (both for profit and non-profit) are required to return a signed and completed copy ofiht the festival coordinator three (3) weeks prior to this event. . F ^ate(s): 5^/70 " 1 P., The following is information about my organization/business: -------------- j Un N gt st <;Tfv>tT^rA ^5^03 Phone: ( ) ft ft L'l Alternate: (L-f D $ ) ^^>1) I) I ------------- List food to be sold or given to the public: E 0 ft 5 i PH N 1^(5 .........22Z. . ‘ :V|Yes[Z]No : 'r,----jmmercial facilities: LXLYes No - Hl- K-r /; Iv .7’I L irb1 t H (W\ 1^0^ '5^55 n H Th 7 er- Cr/i/L-rri^ r/V c\ Other (specify): / ______________________________________ Electricity is provided for my booth's use^SJ Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operatiorr^J Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove Double steamer Electric stove top