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Environmental Health Department <br />lequiied to return n wjned and competed cop-^ c4 lha choci.kst to <br />1.I.Namo ot Evert <br />2 <br />Phono <br />3. <br />5. <br />6 <br />9. <br />rua <br />meats, tamolM. ccofcad brnns. dee. <br />7 <br />B, <br />SAN JOAQUIN <br />—coun r y <br />(■n’nt $$ «,im. h,'tr <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Alw-wle ( 20S I 4l6-ft2fi6________ _______ <br />LKl tood to bo soW cr gnren Io th® pubfcc J2.21J- *' r:'f coH- ■■»\ ter or a ,r ^a'-‘ <br />Noto: Examples ot potentletly hazardous food Include: <br />vegetable, potato salad, eggs, and dairy products. <br />1868 E Hazelton. Avenuo | Stockton California 95205 | T 200 468-34201 F 200 464-0138 I www.sfcchdeon <br />C/,W, riMPSvfcM/W <br />Note: TF« only opecalJons not tequred to prootle rmclosod trills ate those which seh beverages from <br />MpptoviH drtpeiHRr*. or prrrtiackaged foods Item apfxovwl sources <br />Approved wnter lor drinking, ulens I and hnrd washing will be pro-zdwd in my booth by lhe folfowing metheds. <br />O Approvod bottled water <br />I nm piozdng food that n NQT prepped «! horn* fcj Yw No <br />All f«xf n (xeparted on-sile or is fran appnwwd conimerciBl facilrtiej 0 Yes I-) No <br />Name dtaclity. ________________________________________Phono., ;___________ _____ _____ <br />Address oi facAty, _ <br />I ant provtdrg a booth with tho folowing (to protect rny impackaged feed ano food-preparation areas from fire* <br />dtnrt and the public.} <br />LI A booth with walk and ceiling cons’ructed of either wood, canvas, plastic trabr in.iteilai and f ne math 11/ <br />screer.-ng. comptetey enclosing open food areas. Il wiO also have a smooth ard cteanab’e- fleer (concrete <br />areas Ir Uie’puM WTW0(h ‘fl'00<} afo occ®P<aW®) constructed to separate food and food preparation <br />Q Olnei (specify). enrJoswd Ira Icr___________________________________ <br />All feed vc.-do's (both for profit ard non-profit) are i-^_l <br />t'u» festival cooronntor three (3) weeks p.<v to this event. <br />L57J Oh Fa’m©rg Ma'M.I Ddte(s) { 2^7-2/-/ <br />O On-ile hose bib that Is connected to a potable- water source, <br />F": Other (specify): ’ar. Ijo^j; l,f'Mi wyater tank ______ riectocity is pro* tied for n»y booth's use Q Yes No ' ’ <br />I am providing an accurate prete the-merr'etar |0 measure thfi hot end edd holdrxj of potentially haza-dcxis <br />feeds during all trr«s of booth operation, 0 Yes L'J Wo <br />I am p-'OTtding Inc foflewirg hot tempcratare control for the hot haMmg d all polar* ally hazardous foods above <br />136*1, <br /> Camp stove Stemo & hotel trays <br /> Double stownor stoom table & Ids <br /> Etocirc stove lop O Othe' (speofy) <br />Ilia fofcN/ng is mforrnalior. abCA.1 my orgonxaborVbusreM <br />Nar’wof 0fgntwalw'v'bMM-.e^s~ s ’ r,,'i <br />Address •»12 Bifrim Way I'n 2 Mtxtesti CA 95350