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r <br />Environmental Health Department <br />i. <br />2. <br />3.t <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />O 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 />135°F: <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br />SANJOAOUIN <br />—-COUNTY----- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />{✓^Yes No <br />_______Phone: (*^16 ) <br />SqcYawsgsAtp t O', fir \ I <~^> <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EM0 18-C2 Page 7 of 11 TEMP EVENT APP <br />06/1IV19 <br />I <br />vjrvM- t SacyotwyetATo Cfl- 1 *~=>________ <br />jbrotect ifly unpackaged food and food-preparation areas from flies. <br /> Other (specify): / <br />Electricity is provided for my booth's use: Yes E 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. Yes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Date(s): <br />)oX\t> <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 />Alternate: (Jlo ) ~ 6 3> <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 />1. Name of Event ‘^jpvVlVDyy 'feft <br />The following is information about my organization/business: <br />Name of organization/business: cXm <br />Address: /A/ 91-7^. <br />Phone: (HA ) 3b?^> Q, <br />List food to be sold or given to the public: dy y A > <br />I am providing food that is NOT prepared at home: Yes E^No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: _____________ <br />Address erf facility: I <br />I am providing a booth with the following: (to <br />(fast and the public) <br /> 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, cle^n tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Qfother (specify):