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83^ <br />Envh’onmentail HeaBth Depairtment <br />t- <br />in >• <br />1. <br />2. <br />0^ ^6^l/o <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />lis checklist to <br />M -qlz-s <br />i Lix£t ■ <br />-, 7z2/j-l^g <br />5 are those which sell beverages from <br />apZrS rpe“nse'r“s, pre packaged 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 />I “pr» ,he h°' and C°ld h°ldin9 °f P°tentia"y haZard°US <br />I am priding thefoSg hoH^Xe^oX^oHhe hot holding of all potentially hazardous foods above <br />135°F‘ Camp stove Sterno & hotel trays <br /> Double steamer 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 />1868 E. Hazelton Avenue | Stockton, California 95205 209 468-3420 | F 209 464-0138 | www-s^f[jp-EVENT APp <br />EHD 16-02 a9e ° <br />SANJOAOUIN <br />• !i' . ----COUNTY----- <br />Grctiliit'.ss i/inv.s ht'ic. <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 cte] <br />the festival coordinator three (3) weeks prior to this event. <br /> <br />f .Name of Event: UOfUt'-’SE----------------------------------------- ^(sj: <br />The following is information about my organization/business. <br />Name of organization/business: ,P~Ti3O V'V Lt J t <br />MU5 £■ ftlmdxYi ffvive-N <br />Phone: Alternate: _ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared al home: Yes No <br /> <br />fampouWhgaboolh Mb -.-'.rq <<o my wipmbi.ged loo) aid feod-prepa.alion areas bom f... <br />dust and the public) <br />areas from the public. <br /> <br /> Other (specify):________________________ <br />Note: The only operations not required to provide enclosed booths