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ij <br />Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />COUNTY <br />E. HazeHon Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 I www.sjqov.ora/ehd <br />Page7of11 TEMP EVENTAPP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) arc required to return <br />the festival coordinator three (3) weeks prior tn this <br />1. <br />a signed and completed copy of this checklist to <br />1. Name of Event:'' Date(s): JI" <br />The following is information about my organization/business: <br />Name of organization/business:TTflflfr QalreZlM, <br />Address: 73Y7 ^PC <br /> Alternate: ( <br />jyii —4^__yc yg CA KM/ <br />Phone: Alternate: ( ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: E^YesO No Z 1 <br />All food is preparedon-site or is from approved commercial facilities: B^es No <br />_ Phone: Zf <br />4. &/_________erf. <br />'following: (to protect my unpackaged food and food-preparation areas from flies, <br />Name of facility: <br />Address of facility:/?^ / 'TtfyTP <br />I am providing a booth with thi <br />dust and the public) <br />oon8t?,c?d either wood, canvas, plastic, similar material and fine mesh fly <br />PenhT tely ®nclosin? °Pen f00d ^eas. It will also have a smooth and cleanable floor (concrete <br />areas fromTe pK W0°d acceptable) and constructed to separate food and food preparation <br />□ Other (specify): l-fAilr./' <br />Note: The only operations not required to 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 toe following methods: <br />D^pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):/___________________ <br />Electricity is provided for my booth’s use: t^Yes No ’ “ <br />1 "’6 h0, and °°ld hazardous <br />1 3iI35P»FVidin9 thS fOllOwing hot temP«>rature control for toe hot holding of all potentially hazardous foods above <br />EXamp stove S'^temo & 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.