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Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6, <br />9' ' <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Other (specify): ___________—..—------------------------— <br />Note: The only operations not required to provide enclosed booths <br />1868 E. Hazelton Avenue | Stockton, California 95206 | T 209 468-3420 ( F 209464-0138 | www.sjcehd.com <br />EHD 16-02 I’a(jn7of11 <br />07/3/17 <br />I.Name of Event: <br />The following is information about my organization/buslness: <br />'fiosds PoHtw <br />a /■ 1/ y ia <br />Q'A booth with walls and ceiling 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 />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.bo.oth by the following methods:.. <br />[71 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):------------------- --------- —--------------------------------------------------------—— ^7— <br />the hot and cold hpldlng of potent^ hazardous <br />I am hot Mir® of ainsdt&tfelly <br />135T: <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top El Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />.^SANJOAQUIN <br />atm / ---COUNTY------- <br />■’‘''E.-ov.'''-' Grc-uincss grows here. <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^jis checklist to <br />the festival coordinator three (3) weeks prior to this event. O/XT , cOJcCfj <br />S-fr&j' Fait' 4 5~|»s - 3fxg <br />Name of orsanization/buslnsss:.. fSOOUO <br /> ^5I jACfeoh AV^., <br />Phone: Alternate: ( ) <br /> List food to be sold or given to the public: ---------------------------------—— <br />I am providing food that is NOT prepared at home: j^Yes No <br /> <br />Address of facility: I J"AVC7----------------- - ----------- - ------------ - —— <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)