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r <br />- <br />Environmental Health Department <br />2 <br />cA c\ sjj /L <br />) Phone: <br />3. <br />4 <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br />O Approved bottled water <br />/. O <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 />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />Date(s): ? I ~ Z/> - Z / 1 <br />1 <br />SAN JOAQUIN <br />-----COUNTY------ <br />Gredtntfss grotft <br />TEMPORARY FOOD VENDOR S APPLICATION <br />O On-site hose bib that is connected to a potable water source <br />Other (specify): /fct , ('f'/' / 5 <br />Electricity is provided for my booth's use: Yes [J No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation: Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: z <br />O Camp stove /\/ <br /> Double steamer <br />0 Electric stove top <br />c^£L <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 1 Name of Event SA P / <br />The following Is Information about my organization/business: <br />Name of organization/business <br />Address. /—ss <br />i7-XT- Alternate: ( <br />List food to be sold or given to the public: F ~f~t/' <br />I am providing food that is NOT prepared at home: Yes O No <br />All food is prepared on-site or is from approved commercial facilities: JXj Yes O No . / / ? <br />Name of facility. /A. Phone: J Q ~ <br />Address of facility: 12-}/ , 7'^' 5 7^ / S , C/l~ V j V"/ <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 />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 />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.