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<br />Environmental Health Department <br />1 Name of Event 1 <br />2 <br />Address <br />)Phone <br />3 <br />4 <br />YA ovY VAcvfce*-' <br />5 <br />those which sell beverages from <br />6 <br />the hot and cold holding of potentially hazardous <br />9 <br />meats, tamales, cooked beans, rice,Note Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7 <br />8 <br />SAN JOAQUIN <br />-COUNTY <br />G/col nr is here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />jS^pproved bottled water. <br /> On-site hose bib that is connected to a potable water source <br />List food to be sold or given to the public <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 /> Other (specify) ____--------------------------- ---------------------------------- <br />Note: The only operations not required to provide enclosed booths are <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 />I am providing food that is NOT prepared at home ^^Yes Q No <br />All food is prepared on-site or is from approved commercial facilities E^Yes No <br /> Name of facility ---------Phone (--------)---------------------------------- <br /> famproviding abooth with the following (to protect my unpackaged food and food-preparation areas from flies <br />dust 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 cleanab'e flo°r (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />1868 E Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHO ie-02 Page 7 of 11 TEMP EVENT APP <br />08719'19 <br /> Other (specify) ___________—-------------- <br />Electricity is provided for my booth's use ^.Yes LI No <br />I am providing an accurate probe thermometer to measure <br />foods dunng all times of booth operation ®-Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135‘F <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Date(s) 0^ <br />I <br />tThe following is information about my orgamzation/business: <br />Name of orgamzation/business C O Af 6--------------------- - <br /> Alternate (