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Environmental Health Department <br />i."I.Name of Event:Flavor Fest .Date(s): 05/14/22-05/15/22 <br />2.The following is information about my organization/business: <br />Name of organization/business: Ausalda Food Company <br />Address:2963 Appling Circle <br />Phone:(209) 981 8760 Alternate: () <br />3.List food to be sold orgiven to the public:Hawaiian Food <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Approved water fordrinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />O' 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 foodsfrom approved sources. <br /> Other (specify): <br />Electricity is provided formy 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 />SAN JOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Stemo & hotel trays <br /> Steam tables lids <br />O'Other (specify) <br /> On-site hose bib that is connected to a potable water source. <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 />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. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foodsduring all times of booth operation: Q'Ves No <br />I am providing the following hot temperature control f orthe hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />I am providing food that is MOI prepared at home: QYes No <br />All food is prepared on-site oris from approved commercial facilities: E3 YesQ No <br />Name of facility: N/A Phone: ( ) <br />Ad d ress of f acil ity: <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)