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Department <br /> EnVironmental Wealth D p <br /> SO ��A��,N <br /> lCOUN <br /> �ppp VENDOR'S APPLICATIO <br /> TEMpO�`RY signed and completed copy of this checklist to <br /> non-profit)are required to return a sig I <br /> vendors(both for profit and prior to this event. faate(s): <br /> All food 3 weeks <br /> the lestival coordinator three( )) <br /> 1 1.Blame of Event: ''"- <br /> anon about MY organizatianlbusiness <br /> The following is information STIR <br /> Nape of org <br /> anizationlbusiness: �£ In <br /> �a vu- <br /> G Alternate'.( ) <br /> Address: 3 <br /> phone: (7b? � <br /> to the public! <br /> 3. List food to be sold or given <br /> home:2Yes <br /> 11 No �No <br /> at es ys p <br /> roviding food that is r prepared <br /> 4 1 am p a roved commercia4 facil�s'- phone 701 <br /> ared on-site or is fr°sn Ppr flies, <br /> All food is prep �]e�t y �� p <br /> riV1 ed food and food-preparation areas ro <br /> Name of facility: !L �� ♦ $. to protect my unpackag <br /> Address of facility: mesh f y <br /> 5 lam providing a booth with the to lowing concrete, <br /> ubfic} can-Vas, plastic,similar material and fine <br /> E dust and the p and food preparation <br /> 73 constructed of either wood, arate food <br /> It wi14 also have a smooth and c4eartab4e oor <br /> booth with wads enc4os. open food areas. and constructed to seP <br /> Na, completely smooth wood are acceptable) <br /> screening, sand <br /> asphalt, clean tarp _ <br /> the public. r m f <br /> areas from L which sell beverages from <br /> �m00 kL <br /> Other(specify). provide <br /> enclosed booths are those <br /> operations not required to P roved sources. methods: <br /> The Only P or repackaged foods irom Opp booth by the following <br /> Note: erasers, p in my <br /> �ofiple approved disp washing will be provided <br /> tee utensil and hand <br /> 6 Approved water for drinking, <br /> h pe�fiit Approved bottled water. water source, <br /> on-site hose <br /> bib that is aannected to a potable <br /> }� �'No holding of potentially hazardous <br /> Other(Specify) booth's use:❑Yes hazardous foods above <br /> Electricity is provided far rnY robe thermom �eSsoure the hat and a 1 potentially <br /> B. providing an accurate Probe eraiian'•.�J <br /> g 1 am p all times of booth p erature control for the hot holding <br /> foods during hot temp <br /> g t am providing the fallowing <br /> 135°p: sterno&hotel trays <br /> Camp stove Steam table&Ws <br /> Double steamer Other(specify) N I cooked bear <br /> Electric stove top hazardous <br /> food include: meats, tamales, <br /> F � of potentially s and dairy products. <br /> Note: Examples salad,egy <br /> vegetables,p F 209 464-0138 f ww\`' <br /> Stockton,California 95205 I T 209 468-3420 <br /> Page 7 or 11 <br /> 1868 E.Ha2elton Avenue y <br /> �ergycFrj y�'iq EHO 16-02 <br /> 9 ' 0M117 <br /> StOCklon <br /> Cali"°rn <br />