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Date(s): 7-4-V\ — <br />2. <br />3. <br />4. <br />5. <br />6. <br />connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />33^ 33W <br />Environmental Health Department <br />EHD6?6^HaZeltonAVenUe| Stockto'', California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />07/01/2024 Pa9e 7 Of 11 TEMP EVENT APR <br />SAN JOAQUIN <br />COUNTY <br />Grcatnc.s's here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks prior to this <br />1. <br />A- 1A '(C, ■> <br />ar! eventred 3 completed of this checklist to <br />1. Name of EventA j sWeeA-OiZ <br />The following is information about my organization/business: <br />Name of organization/business: A A.VA <br /> <br /> Address: ^2.5. G sV s WArxtA LG qs?i04 <br />Phone: Alternated ) <br />List food to be sold or given to the public: T^.F. F., Tr,,-U. (Q |( z, „ <br />I am providing food that is NOT prepared at home: ElYes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Phone: l£. Name of facility: /-,> J r- - 1’ <br />Address of facility:^ 4 V S, u r <br />Tost and the pub^ h fo"^: pro'ect ^P^ckagedfoodandfood-preparation are» from hies, <br />SXXSyXSZ food dareaesi,h H “k™5' SMar material and <br /> Other (specify): ■Vnr>A "1 K . <br />N°te: Inn J™1* °Peratjons not required to provide enclosed booths are those which sell beveraaes from <br />approved dispensers, or prepackaged foods from approved sources. everages from <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />0 On-site hose bib that is <br /> Other (specify):__________ <br />Electricity is provided for my booth's use: 0 Yes 0 No ------------- ----------------------- <br />' foXXT^ ,ha h°* aad “ld h°'^g «y hazardous <br />1 a^5PorFOV,d,n9 the follow’n9 hot temperature control for the hot holding of all potentially hazardous foods above <br />0 Camp stove stemo & hotel trays <br />0 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.