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Environmental Health Department <br />2. <br />Phone: <br />3 <br />5 <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />1868 E Hazelton Avenue | <br />05 <br />209 464-0138 | www <br />the hot and cold holding of potentially hazardous <br />all'times hot holding of all potentially hazardous foods abow <br />Qo\d h-ennS oc\S <br />I am providing food that is NOT prepared at home: Yes [yj No <br />AJI food is prepared on-site or is from approved commercial facilities. Yes No <br />Name of facility: L/pIQn CcaV-COYTCI_________Phone: -------- <br />Address of facility: 6 kAVA\0V^ -----C (\-------------------------------- <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 />Fl A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />saeening, 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): FOO f £ H VZ----------------------- ------------------------------------------------- <br />Note- The only operations not required to provide enclosed booths are those which sell Peerages from <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 />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />|3 Other (specify): ------ <br />Electricity is provided for my booth’s use: <br />I am providing an ■ <br />foods durii <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />hazardous food include: <br />Stockton. California95205| 7,20946S-M201 F <br />SANJOAOUIN <br />COUNTY <br />Greotness grow$ here <br />TEMPORARY FOOD VENDOR’S APPLICATION <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: 6 Vx) vA YOC 1 Date(s): *3 / ( C>( - 2-3, <br />The following is information about my organization/business: 'u / "2 I / 2 <br />Name of organization/business: 00^1/1 $ <br />Address: 2- Fn \<t f~ C V | ru.y> <br />(2^ ) Q <i2 A 1 Z ^( Alternate^ ) <br />List food to be sold or given to the public: <br />Yes No <br />accurate probe thermometer to measure <br />I am providing the following hot temperature control for <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Not.: Examples of pofenfally hazardous