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Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return <br />1. <br />2. <br />Name of organization/business: <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />cooked beans, rice,meats, tamales, <br />7. <br />8. <br />209 464-0138 | www.sjcehd.com1868 E. Hazelton Avenue | Stockton, California 9520p|^7Tof n°9 468 342° 1 <br />EHD 16-02 <br />07/3/17 <br />SAN JOAQUIN <br />------COUNTY------ <br />Greatness qrovvs here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />Date(s): .Q/ <br /> Other (specify):------------------------------------------------------------------------------------ <br />- “• ““ - w “ <br />(3 Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br /> <br />FSShXdjXe^ermSr “measure the hot and cold holding of potentially hazardous <br />, XvZ rhe «:w°ngOhot Ko“r £e hot holding of all potentially hazardous foods above <br /> Camp stove Sterno & hotel trays <br /> Double steamer 3 Steam table & lids ~ <br /> Electric stove top other (sPec,fy) <br />Note: Examples of potentially hazard°u.s <br />vegetables, potato salad, eggs, and dairy products. <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Pl PXTfi CaVGuS <br />The following is information about my organization/business. <br />........... ■ StfUav (hv?x-p \i'~\C---------------- <br />fTsyrcg-rcAQ P- ------------------------ <br /> Phone: (CHA ) ----------------------- A“ < >---------------- ----------------------- <br />List food to be sold or given to the public: V Q rrCnCXote,----------------------———— <br />I am providing food that is NOT prepared at home: Yes No <br />AH food is prepare^ on-site or is from <br />Name °f faCility: -------------F~ <br />dust and the public) <br />$ A Wolh MH -alls ard ceilng CSJlS <br />areas from the public.