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a <br />1. Name of Event:1. <br />2. <br />Address: <br />Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />5. <br />£>- <br />6. <br />Ei <br />meats, tamales, cooked beans, rice,Note: <br />vegetables, potato salad, eggs, and dairy products. <br />\<A.CC \ ~?-c\ Q .9 i <br />I <br />1: <br />Note: The only operations not required to provide endosed booths are those which sen 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 />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /><r.; UHH.'rJVHWUlIl .................... <br />■'/ --'COUNTY------- <br />Grsctncs.-’i grsv-'s her-s. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />8. <br />9^ <br />Date(s): ^[zi- <br /> Other (specify):---------------------------- - --------------------------------------------------------- <br />F'.TSX"- X—» K™ »«».« «— <br />135T: <br /> Camp stove Sterno & hotel trays <br /> Double steamer O Steam table & lids <br />|~~| Electric stove top D Other (specify) <br />Examples of potentially hazardous, food include: <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^hd^ <br />EHD1&O2 Page7of11 <br />06/29/2023 <br />I am providing food that is NOT prepared at home: Yes B^o <br />All food is prepared on-site or is from approved commercial facilities: Yes^^o <br /> Name of facility: __________i —--------—-----------------Phone. (-------)----------------------------------- <br />Address of facility:------------------------------------------------------------------------------ ----------------------------------— <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />n A booth witfi walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />^Pother (specify): firC- <br />Note: The only operations not required to provide enclosed booths <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />RIVER ISIAMQ5 <br />The following is information about my organization/business: <br />Name of organization/business: -----------------— <br />( St© ) ___________■ Alternate: (------)------ZZZ------------