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Environmental Health Department <br />i. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />» • <br />which sell beverages from <br />6. <br />9. <br />7. <br />8. <br />meats, tamales, cooked beans, rice, <br />SANJOAOUIN <br />------COUNTY------ <br />Greof -ss c ' -s <br />All food vendors (both for profit and non-profit) are <br />209 464-0138 | www.sjgoVpOrg/ehdpp1868 E. Hazelton Avenue | Stockton, California 952^ 209 468 3420 ' <br />EHD 16-02 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checkllStJ^^^/ <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event:.Date(s): <br />The following is information about my organization/business. <br /> <br />Name of organization/business:1133^ T?/7 -----------—— <br /> <br />(---------------------- Alternate: <br /> List food to be sold or given to the public: ----------------------z—1— --------- <br />I am providing food that is NOT prepared at home: [^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Phone: ( )____________________ <br />Name of facility:____________ <br /> <br />dust and the public) <br />aA booth with walls and ceiling constructed of either wood canvas, p.as^similar -^lan^ne ^strfly <br />S to separate food and food preparat.on <br />areas from the public. <br /> Other (specify):________________ <br />Note- The only operations not required to provide enclosed booths are those <br />approved dispensers, or prepackaged foods from approved sources <br />Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br /> Other (spe'Cify):—pq —--------------iamrpCrOTiding°ane^^at^p^e^TCTTno^ter to measure the hot and cold holding of potentialiy hazardous <br />I a"^9 ZTlZX^ZXHXi for the hot hoiding of all potential.y hazardous foods above <br /> Camp stove Stemo & hotel trays <br /> Double steamer s,eam table & l,ds <br /> Electric stove top pother (specify) / <br />Note- Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.