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Environmental Health Department <br />Date(s) t S1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />^oo) ^20 <br />5. <br />which sell beverages from <br />6. <br /> <br />9. <br />7. <br />8. <br />__ Alternate. (92S' ) <br />ChoJe <br />SAN JOAQUIN <br />C OU NT Y- <br />meats, tamales, cooked beans, nee, <br />are required to return a signed and completed copy of this checklist to <br />;event <br />(hC3> ) - || OQ______________ <br />List food to be sold or given to the public: pgs <br />1868 E. Hazelton Avenue | Stockton, California ^520p|gl /of209 <br />EHD 16-02 <br />07/01/2024 <br /> Other (specify):------------------ <br />Note: The only operations not <br />approved dispensers, < , <br />Approved water for drinking, utensil a <br />(zf Approved bottled water. <br /> on-site hose bib that is connected to a potable water source. <br />ff\ ___________ <br /> 13" o B <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) arc <br />the festival coordinator three (3) weeks prior to this <br />1 Name of Event DA/ <br />The following is information about my organization/busmess <br />Name of organization/busmess CHfiiAT <br />— pro°be thXcte^ to ^asure the hot and cold hoidtng of potent,a«y hazardous <br />. the hot holding of all potent,aily hazardous foods above <br /> cX stove 0Sterno& hotel trays <br /> Double steamer Steam table & Ids <br /> Electric stove top other <br />NntP- Examoles of potentially hazardous food include: <br />NOte’ vegetables, potato saiad, eggs, and dairy products. <br />,U required to provide enclosed booths are those <br />or prepackaged foods from approved sources. <br />,nd hand washing will be provided in my booth by the following methods; <br />F 209 464-0138 , www.sjgovterg/ehd^ <br />I am providing food that is NOT prepared at home 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities 0 Yes No <br />Name of facility: -----------------Phone (32A. <br /> <br /> "XTbo-s^^ ,rom flie5' <br />dust and the public) <br />0- A booth with walls and ceiling constructed of either wood canvas. XrawiTftoor (concrete. <br />anS S arfaS^ble) and constructed to separate food and food prepare.,on <br />areas from the public.