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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />1 <br />5. <br />It will also have a smooth and cleanable floor (concrete, <br />6. <br />9. <br />I No <br />measure7. <br />8. <br />[\ZpApproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />2'Yes No <br />Phone: (___ <br />SANJOAQUIN <br />-----COUNTY------ <br />Greenness grows '-ce <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Site?'' <br /> Other (specif^:----------------------------- <br />“—Sr— “ « « “» <br />, X.S SXTX—" •««■■ —>•— <br />135°F: <br /> Camp stove Stemo & hotel trays <br />Q Double steamer O Steam table & lids <br /> Electric stove top (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgoy.or^ehd^ <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. • ' <br />I.Name of Event: Datefs):/^^ <br />The following is information about my organization/business: <br />Nameoforganization/business: <br />Address: <br />7 Alternate: (JdXy ) 3^7 <br />List food to be sold or given to the public: Sticks : cUdXU V<l ,,£c] sM <br />I am providing food that is NOT prepared at home:j2i es O No <br />All food is prepared on-site or is from approved commercial facilities. <br />Name of facility: <br />providing 'abooth 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 matenal andI fine mesh fly <br />screeninq completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparatio <br />areas from the public. * • <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 />meats, tamales, cooked beans, rice,