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Environmental Health Department <br />* r ’ <br />' r. <br />1. <br />2. <br />Address: <br />)____Alternate: ( <br />QOO^^ <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Note: Examples <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www s*^[jpgV0ErJ’TAPp <br />ehd 16-02 pafl0 0 <br />07/3/17 <br /> Other (specify):----------------------------------------------------------------------------- <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 /> Other (specify): ----------------- ------------———=—------------------------------------------------------------------------------- <br />rim'SZanS ““ h°ldi"9 °f ha“ <br />I e'mproX9 SSXPcXl foHhe hot holding of all potentially hazardous foods above <br />135°F- Camp stove Sterno & hotel trays <br />Q Double steamer O Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />SAN JOAQUIN <br />-----COUNTY------ <br />Giculni’s* yitr.vs • <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 this event. <br />I ndi PizJrtr — MaxLcF Date(s): , <br />1. Name of Event: -------------2------------------------------------------57/^/ <br />The following is information about my organization/business: <br />Name of organization/business: ------------------------------------------------------------------ <br />------------------------------- ------------------------------------------------- <br />Phone: ( ------ <br />List food to be sold 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 facilities: jZ Yes No , <br />ri l+mvY’ ______Phone: (------------------Name of facility: , TTO”^ -------- -------—-Xr°^ingCX-ot^^hePfol^ (t^t W un W^odStpreparatlon areas from flies, <br />dust and the public) <br /> A booth with wails and ceiling <br />SphaT’cieaX^^and smooth Xd are acceptable) and constructed to separate food and food preparation <br />areas from the public.