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i <br />tcklist to <br />All food vendors (both for profit and non-profit) <br />1. <br />2. <br />Address: <br />3. <br />4. <br />flies, <br />5. <br />from <br />6. <br />9. <br />ice,meats, tamales, cooked beans, <br />Note: Examples of <br />vegetables, potato salad, eggs, and dairy products. <br />)________ <br />8. <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | <br />EHD 16-02 PageZofU <br />07/3/17 <br />F 209 464-0138 | www.sjcehd.cor' <br />TEMP EVENT APP <br />Environmental Health Department <br />" ) are required to return a <br />AMI IUUU VGHUVIU r*-" — - ------- • J <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: ---------------------- <br />The following is information about my organization/busmess: <br />v- 56(7^ (&A <br />0/ ----------- <br />” > are those which sell beverages <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 />I ^X9 the hot holding of all potency hazardous foods Xove <br />□T^pstove □ Sterno & hotel trays <br /> Double steamer Steam table & lids f <br />Q Electric stove top O Other (specify) ) <br />potentially hazardous food include: <br />Name of organization/business: <br />ft) Itfiz ________________ <br />Phone: ( % ) ( <br />List food to be sold or given to the public:------ <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: [&Yes No <br />rx Phone: ( <br />. frol “o X areas fr0 <br />dust and the public) <br />□ A booth with walls and ceiling constr^‘ed e'th®r "“alsThave a'smooth^nd deanabletoor (c'lcretZ <br />:Csphealincie*and — Xd acceptable) and constructed to separate food and food prep^on <br />areas from the public. <br />Other (specify): /V-^ <br />Note: The only operations not required to provide enclosed booths <br />SAN JOAQUIN <br />------COUNTY------- <br />-•si r'rj-’z'S <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />signed and completed copy of this cl <br />________Date(s):