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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9.. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />eho6?m2 Ha2elton Avenue I Stockton, California 95205 | T 209 468-3420! F 209 464-0138 | www.sjcehd.com <br />07/3/17 PaQe 7 of 11 TEMP EVENT APP <br /> <br />!ted copy^f this checklist tg^ <br />v ——■ ■— f f <br />. SAN JOAQUIN <br />-COUNTY------ <br />G-ec: -i;: ; j hCr;. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />f°°^ven{,ors (both for profit and non-profit) are required to retun <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: <br /> Date(s): <br />The following is information about my organizatfon/business: <br />Name of organization/business: <br />Address: <br />(~ -3 Alternate: (2c. y ) SG— Ay / S~ <br />List food to be sold or given to the public: ‘'fa. *f\f> <br />I am providing food that is NOT prepared at home: 0<Kes No <br />All food is prepared on-site of is from approved commercial facilities: QS'es No <br />Name of facility: Phann-?^ 4^ S 7^ S <br />Address of facility:iCe-az>4< <-Ji <br /> ' XSS puWfc? the f°!IOWin9; (t° pr°^Ct mV ^packaged food and food-preparation areas from'fii^ <br />^ShXh^iiSv COns,:uct:d of either wood- ca^s. Plastic, similar material and fine mesh fly <br />asohaTcieSn^nd areaS' 11 Wil1 alS0 have a srT,ooth and cleanable floor (concrete <br />areas ^m ^Xfc acceptable) and constructed to separate food and food preparation <br />EfOther (specify): ___________ <br />N°te: 1™^ °perations not re<’uir®d t0 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 />LZTApproved bottled water. <br />3 On-site hose bib that is connected to a potable water source. <br />EfOther (specify): <br />Electricity is provided for my booth’s use: 0 Yes No ———----------------------- ------------------------ <br />1 “5Tre"" “ ’na ho“n9 of po“ia"y hazarflous <br />1 an? pr°.vld,n9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />i oo r*. » <br />Ef Camp stove pTStemo & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top Brother (specify) \ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.