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Firefox aboucblank <br />Environmental Health Department <br />1, <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tainalos, cooked beans, rice, <br />3/6/2024, 11:34 AM1 of3 <br />7. <br />8. <br />h^yb^wing: (to protect my unpackaged food and food-preparation areas from flies, <br />pW^SANJOAOUIN <br />''z C O U N T Y—- <br />■G'iVUl rn-5 5 (/r.'jivs <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />DatefS):y^ -7/4/z/ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www.sjcehd com <br />EHD1M2 rOBo7of11 IEMPEVEN1AM <br />07/3/17 <br />I_| on-site hoso did mat is connecieu 10 ti puiduie , <br />hm'prcvidi^anS^ probe utXo^eH'Sasure Uw hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes Kl No N//\ . <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />O Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 threeis) weeks prior to(this event. ■ . <br />1. Name of Event: <br />The following is information about my organizatlon/buslness: <br />Name of organizatlon/buslness: <br />Address:__________________// K) > 'yf ■ //Ojh------- <br /> <br />Phone: (&f) <X> "53 Alternate: ( ) <br />List food to be sold or given to the public: ^■.z'------------------- <br />I am providing food that is NOT prepared at home: Yes CJ No <br />All food is prepared on-site or Is from approved commercial facilities:]^ Yes f ] No <br />Name of facility: A rVl Phone: ()-------------------------------- <br />Address of facility: <br />I am providing a booth withjl- <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 (conciete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. / / /^ fl <br />pother (specify): d <br />Noto: 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 hoso bib (hat Is connected to a potable water source. <br />Mother (specify): ^4^ gWU- Q_____________________