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bcf(e <br />5 <br />meats, tamales, cooked beans, rice, <br />'W <br />Environmental Health Department. <br />I <br />F,aze,ton Avenue 1 Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | wmv.sjgov.org/ehd ? <br />8SS <br />‘C- SANJ01QUIN <br />— COUNTY--.. <br />. -Gj-enrness <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />A1J focd vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />coordinator three (3) weeks prior to this event. <br />i. 1. Name of Event: lU(h ^&r|ctT Date(s) <br />2 The following is ihforrnat on about my organization/businass: <br />Name of organ ization/business: S I fU DI) A ’ <br />Address: ^.0 lIlc'V c A q^^z. <br />Phono: (2^) I __ Alternate: ( ). <br />3 List food to be sold or given to the public -Jcl I LX.A , S IjK /A p^,; OA <br />I am providing food that is NOT prcparcd at home:^ Yes □ No . <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No <br />Name of facility: 4ms 6A kX£iLi-QUA Phone: ^8 I ^'^"1 <br />Address of facility:__U I pQ (’ TA a .SK >|d- (?A . .________ _ <br />I ajri pfov.’dmg a booth with the following: (to r.roteot my unpackaged food and fbdd-preparatipn areas from flics. <br /> A booth with walls and ceiling consinjctod of either wodd; canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areasf It will also have a smooth and cleanable floor (ccncrete. <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from' the public. <br /> Sather (specify):______________CVA iTJAp.-j <br />Note: The only operations not requirea to provide enclosea booths are those which sell beverages from <br />approved dispensers, orprepackaged foods from app(oved sources. <br />6. Approved water for drinking, utensil and hand washing will be proviced in my booth by the following methods; <br />N/ A <br /> Approved bottled water. <br /> On-sne hose bib that is connected to a potable water source <br />■ <br />.□•Other(specify): <br />pufontialiy bazsrdcus <br />9. I fi Ad.ng of all rx,t«rit:ally Iwmamm 'o=ds above <br />. □.Camp stove : • Stereo & hotel trays <br />■□Double steamer te] Steam table & I, ds <br />‘ pother (specify) A <br />• •• U-.r. .. ■ . <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.