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Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice,Noto: <br />i <br />I <br />9. <br />7. <br />8. <br />i '.7 , <br />1868 E. Hazelton Avenue | Stockton. California S5205J 209168-3420 | F 209 484-0138 | ww.sjc^dxan <br />07/3/17 <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. <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 /> KBS— Se t^feholding of potent^Z^ <br />I am° providing tliefolfoXg IwUempVraturFcontrolfor 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 />0 Electric stove top Q Other (specify) <br />Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SAN.JOAQUIN <br />-----COUNTY------ <br />h‘,rr-. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed <br />the festival coordinator three (3) weeks prior to this event. f <br /> 1.NameofEvent:_L^Al_^^±— <br />The following is information about my organization/business: <br /> Name of organization/business:---------------------------------------------------- — <br />\Q' _ <br />Phone: \ A 2?Alternate: ( ).-------------------------------- ---------- <br />List food to be sotd or given to the public: <br />I am providing food that is NOT prepared at home^ Yes No <br />All food is prepared on-site or is from approved commercial facilitiesJS^Yes No <br />Name of facility: _— Phone: ' <br />fam providing*3 b?oth with the following: (to protect my unpackaged food and food-preparation areas from fliesT <br />dust and the public) <br />Va booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesfi fly ^^^aH^clean^a^andTmooth Z am fooMoZeparation <br />areas from the public. <br /> Other (specify):------------------ --------------------------------------------------- <br />only operations not required to provide enclosed booths