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Environmental Health Department <br />2. <br />) Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />and food-preparation areas from flies, <br />All food vendors (both for profit and non-profit) are <br />a potable water source. <br />209 464-0138 I www.sjgov.org/ehd <br />TEMP EVENT APP1868 E. Hazelton Avenue | Stockton, California 952^gJi7To(2°9 '168 3420 1 <br />EHD 16-02 <br />06/2Or/O23 <br />SAN JOAQUIN <br />------COUNTY------ <br />G. rnliif j,'. C|frw5 here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. , <br />, ,Name o< Event: WL <br />The following is information about my organization/business: . <br /> <br />Name of organization/business: <br />Address:' <br /> Alternate:/ <br />List food to be sold or given to the public:__ _ <br />I am providing food that is NOT prepared at home: C^'Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />.. .... ____ _ Phone: (____1Name of facility: __________— <br />Address of facility:.----------------------------—---------------- -----------------— - <br />I am providing a booth with the following: (to protect my unpackaged food <br />dust and the public) <br />□ A booth with wans and ceiling constructed of either wood canvas. P^simta " ar^fine mesh fiy <br />S am aS^blel-d constructed to separate food and food preparation <br />areas from the public. <br />ram^XinTan"— 'he “ ““ h0'dln9 POtentia"y <br />t am0proX9 the 0' 8,1 ““J <br /> camp stove Stemo & hotel trays <br /> Double steamer stearn 131,16 & lld5 <br /> Electric stove top Olher (sPeclfV) <br />Note: Examples of potentially hazard°Uf1sal <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify):----- ------- --------------------------------- ---------------------------- <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 booth by the following methods: <br />[ | Approved bottled water. <br /> On-site hose bib that is connected to