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Environmental He 'th Department <br />All food vendors (both for profit and non-profit) <br />Date(s): <br />1. <br />2. <br />^'34^ <br />Address: <br />) Alternate: ( <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />/- // <br />2tt( { <br />f I / <br /> Other (specify): ______ ________ ________—------------ ——— <br />Note: The only operations not required to provide enclosed booths are <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 />fyi Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />X"ermom» Xure the hot and odd bolding o< poBn W h^ardous <br />, aXS bSXX the bd bolding of al! poteniiali, bazardoua foods above <br />135°F' <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />es No <br />4^ 5 . Phone: I------)— -------------------------------- <br />___—— ---------------- ~ <br />$0 protect my unpackaged rood and food-preparation areas from flies, <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd-com^ <br />Pag© 7 ot 11EHD 16-02 <br />07/3/17 <br /> <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-) 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 />1. Name of Event: ------2L_Z^--------------------------------------------Date(s): ~ <br />The following is information about my organization/business. <br />Name of organization/business: <br /> Phone: (^^ --------------- <br />List food to be sold or given to the public: ,< erXfy <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: Yi <br />Name of facility: /^C^-i <br />Address nf facility: <br />I am providing a booth with the following: <br />dust and the public) <br />Y A boofb With »* and =eiS « - a" aXXS XXXXS <br />EXrXtaXnX^ Xd S acceptable) and consbdcfed to sepatate food and food preparation <br />areas from the public.