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Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />(t will also have a smooth and cleanable floor (concrete, <br />6. <br />9. <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <br />I .• <br />V fpnV'" <br />SAN.JOAQUIN <br />■'l' -----COUNTY------- <br />Gicol nc.ss yrcnvs In?/1. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 thlsevent. n-dyd> <br />f. Name of Event: <br />The following Is information about my organlzation/buslness: ( P <br />Nameofor^tto— <br />Hi "Tech Pkwy,' Ccvt<da\e. Ca <br />Phone: ------------------- Alternate: (20^ ) <br />List food to be sold or given to the <br />I am providing food that Is MSI prepared at homei'^Yesn No <br />dust and the public) <br />areas from the public. {Q <br />pother (speolfyhtm?^^^^^ - <br />Note- The only operations not required to provide enclosed booths are those which sell beverageJ 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 (he following methods: <br />El Approved bottled water. <br /> On-site hose bib that is connected to a potable waler source. <br />the hot and cold ho.dlng of potent hazardous <br />t Jm"g th"nXHX™Xrenc»r the hot holding of alt potentWIy hazardous foods above <br />-|3'5OF' Camp stove Eterno & hotel trays <br /> Double steamer I 1 Steam table & lids <br /> Electric stove top Othor (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />•|868 E. Hazelton Avenue | Stockton, California 95205 209 468-3420 | F 209 464-0138 | ww-^?®^,^°lJ'TApp <br />EHD 10-02. °SC <br />07/3/17