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Environmental Health Department <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Phone: 1 ZT3O <br />‘ban__________ -____________-— <br />id food and food-preparation areas from flies, <br />7. <br />8. <br />SANJOAQUIN <br />-----COUNTY------ <br />(>/ col lies S (JlOIVb Ik'IC. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />’< 0 .,V'" <br />1868 E. Hazelton Avenue | Stockton, California 9520M 1^209 468-3420 | F 209 464-0138 | www.sjcehd.com^^ <br />07/3/17 <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. Name of Event: I M ________Date(s): j/lS'lZ'S- <br />The following is information about my organization/buslness: <br />Name of organization/buslness: gATTL- /VtOO --------------- <br />ZZZ- ----------- <br />(2D'}) '~)40-oI7»<«Z>_______________ Alternate: S 57^-------------- <br />List food to be sold or given to the public: tfVbYvO, —-SflLK" J 0 j L2c4.ue.naJ} <br />I am providing food that is NOT prepared at home:"|^ Yes □ No <br />All food is prepared on-site or is from approved comrperclal facilities?^ Yes No <br />Name of facility: V-leavX Phone: ------ <br />Address of facility: IaJP-5^ 'Ct uez' ___--------------------------------------- ------------- ------------- <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 /> A booth with walls and celling 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 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): “IPzAV V\fkV\(MA)A ^VlLYL^ <br />Note: The only operations not required to provide enclosed booths' 5 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 />■rf Other (specify): IkM SMlJ UW ------------------------- <br />^TpSdl^an probe themometer5 to measure the hot and cold hotdinfl of potentially hazardous <br />I am°provldlng Tte foSng^^XpeXPJntolfoX hot holding of all potentially hazardous foods above <br />135*F' <br /> Camp stove Sterno & hotel trays <br /> Double steamer O Steam table & lids <br /> Electric stove top D Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.