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Environmental Health Department <br />All food vendors (both for profit and non -profit) are required to return <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />_.Date(s):.^P l?±5^l <br />1868 H. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjcchd.com <br />07/3/17 <br />SANJOAOUIN <br />COUNIY <br />i. ■. . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: WDI GRAPE FESTIVAL ___ <br />The following is information about my organization/business: <br /> Name of organization/business: <br />Address: <br /> Phono: ) /J--------------------------Al,ema,o: < ------------ <br /> List food to be sold or given to the public: ------ <br />I am providing food that is NOT prepared at home: ^fYcs [. ] No <br />All food is preparedon-site <>r is from approved commercial facilities: |/1 Yes NoName of facility: Phonc; < —1--------------------------------------------------------------------------------- <br />"^^a booth w"iS the foilowing:' (to pmtect my cmpackaged food^ <br />dust and the public) <br />[>| A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine moshi fly <br />areas from the public. /> / ■> J <br /> [ J Other (specify):-------- -------------------- --------------------------------------- ------------------------ <br />Noto: lire 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 bo 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 />l^n^S^n ^SpX tfXSnoUsure the hot and odd holding of potontiaHy hazardous <br />I XroS the Zig ho^ZoX^o'l fir the hot hoiding of all potentially hazardous foods above <br />135°r;: <br />[' | Camp stove I I Sterno & hotel trays <br />| | Double steamer I I Steam table & lids <br />| | Electric stove top I d Other (specify) ///.-// ' ■- '' ) <br />Note: Examples of potentially hazardous food include: moats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.