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Environmental Health Department <br />2 <br />Phone <br />3 <br />5 <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />are required to return a signed and completed copy of this checklist to <br />Datefs):^/0^ <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatnets grows hc-c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Ha2e'lon Avenue I Stockton. California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />9 P*ge7of1l TEMP EVENT APP <br />I am providing food that is NOT prepared at home; R] Yes No <br />All food is prepared on-site or is from approved commercial facilities:>ELYes No <br />Name of facility;Phone; ( ) <br />Address of facility. <br />1 am Prov,d|ng a booth with the following; (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fiv <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />aspha t. clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />S^Other (specifylr/^A^ ‘ <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, utens.l and hand washing will be provided in my booth by the following methods: <br />0"Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Q Other (specify);________________ <br />Electricity is provided for my booth's useU0 Yes No <br />1 Zd7dX"=^ □Tre ,he h0'and cold holdin9 0'po,en,ial,y hazardous <br />I am providing the following hot temperature^ontrol for the hot holding of all potentially hazardous foods above <br />Q Camp stove Q Stemo & hotel trays <br /> Double steamer Q steam table & lids <br />Q Electric stove top [~1 Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1. Name of Event:^^C^^X67/l/ <br />The following is information about my orgamzation/business <br />Name of organization/business:/^/ bh'OfJ cL?, <br />Address: <br />~ Alternate: <br />List food to be sold or given to the public; /Y J 'JA S