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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />cooked beans, rice,meats, tamales, <br />7. <br />8. <br />approved dispensers, or prepackaged foods from approved <br />Approved water for drinking, utensil and hand washing will be provided <br />No <br />___1 <br />209 464-0138 I www.sjgov.org/ehd <br />TEMP EVENT APP1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F <br /> Other (specify): ------------------ -------------------------------------------------------------------------------------- <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /><->r nrcmackaopd foods from approved sources. <br />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 /> Other (specif^:----------------- ---------rn voc IVl --------------------- <br />, XS X»«™ .< —■> »•'«“"" <br />Camp stove Stemo & hotel trays <br />Double steamer Steam table & lids <br /> Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: <br />The following is information about my organization/business. <br /> <br />Nameoforganization/business: <br />Address: I/„---------------- <br />, \ % 1 ~7 Alternate: <br />List food to be sold or given to the public:------------------------------------------------ <br />I am providing food that is NOT prepared at home. Yes Q No <br />All food is prepared on-site or is from approved commercial facilities:^Yes <br />.... Phone: ( Name of facility: ------------------- ------------------ --------------------------- <br /> <br />Xlrorddingabooth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />X booth with wails and ceiling constructed. of etther wood, canvas, plasti.similar -^^-^-XetZ <br />ZhaTcieaMa^an:"^ Xd am acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />4^SANJ0A0UIN <br />-----COUNTY------ <br />Grcotncss grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this <br />Date(s):