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Environmental Health Department <br />All food vendors (both for profit and <br />1. <br />2 <br />Address; <br />3. <br />4. <br />1 <br />which sell beverages from <br />9.4 <br />meats, tamales, cooked beans, dee, <br /> Other (specify):--------------------------------------------- ---------- <br />Note: The only operations not required to provide endosed booths are those <br />approved dispensers, or prepackaged foods from approved sources. <br />isit and hand washing will be provided in my booth by the following methods; <br />6. Approved water for drinking, uten: <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify); r-|v ---------------- <br />\ ,he and ““ h0,d’nfl of p"y "us <br />! X hot hotding of,» potency hazanfeuo foods above <br />135*F' Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br />Q Electric stove top Q Oth;Cr (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products- <br />18M E. Hazelton Avenue I StoeKton. 0.^952051/^ 468-3420 | F 209 484-0138 I — <br />EHD 13-O2 <br />07WIT <br />x%SAN>JOAQUIN <br />/ “CO:U NTY— <br />"ieMPOX FOOD VENDOR'S APPLICAT.ON <br />- I non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks pnoc to this event. -June* ; <br /> <br />------------ ------ <br />The following is information about my organization/business: <br />Name of organization/business; —/ ---------------— <br /> <br />/p jo J" Uukkin* <br /> Phone: -5~7^------------ Alternate:( ) ----------—- <br /> <br />List food to be sold or given to the public: fl'C <br />I am providing food that is NOT prepared at home: Yes'SJto <br />All food is prepared on-site or is from approved commercial faculties: Yes£l Q <br />l. th Phone; £Name of facility.------------------------------------------------------- <br /> fam^rov^dtog'abooth with the following7^~protoctmy~itopec^gad~^faod and foo^preparatiorTareas from Pies, <br />dust and the public) <br /> A booth with walls and ceiiing constntotod of either wood= P-a* ", <br />^ieTta^S S are aXebie) and constructed to separate food end food preparation <br />areas from the public.