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Environmental Health Department <br />( (I <br />1. <br />2. <br />95^^ <br />Address: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />7. <br />8. <br />(S Other (specify) <br />meats, tamales, cooked beans, rice, <br />SAN JOAQUIN <br />COUNTY <br />. ... .... - ■: !>, <■. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />nate(s):^ty <br />hr p\T i .s* < <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209468-3420) F 209464-0138 | www.sjcehd.com^ <br />EHD 16-02 <br />07/3/17 <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Ci—--------- <br />The following Is information about my organizatlon/business: <br />Name of organization/business: Skvvci— <br />Phone: (^ ) 9^ Alternate^ ) <br />List food to be sold or given to the public:/^^ <br />I am providing food that Is NOT prepared at home: Yes 0 No <br />All food Is prepared on-site or is from approved commercial facilities:® Yes No <br />Name of facility:—-------------------------— Phone: ---------------------------------- <br />famprovMbgabooth with the following: (to protect my unpackaged food and food-preparation areas from flies? <br />dust and the public) <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <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 /> Approved bottled water. <br />H On-site hose bib that is connected to a potable water source. <br /> Other (specify):-------------------------—-———— ---------------------------------- ---------------— <br />«.» ««««««p—— <br />, “X™ -.«»«—» <br />135°F: <br /> Camp stove Sterno & hotel trays <br />0 Double steamer 0 Steam table & lids <br /> Electric stove top L_ .. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.