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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 />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />hot and cold holding of potentially hazardous <br />hot holding of all potentially hazardous foods above <br />plastic, similar material and fine mesh fly <br />separate food and food preparation <br />209 464-0138 | www.sjcehd.com <br />TEMP EVENT APP1868 E. Hazelton Avenue | Stockton. California 952^7Tof2°9 468 3420 1 <br />EHD 16-02 <br />07/3/17 <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness arows nere <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />Electricity is provided for my booth’s use:J3 Yes No <br />I am | <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially <br />Date(s): X <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: <br />The following is information about my organization/business. <br /> Name of organization/business: EpWV'AnfYXTrt --------------------------- <br />Rj PtDA r-aro’Scne? P- 75A4T1------------------ <br />(Gy II ) Alternate: ( ---------------------------------------------- <br />List food to be sold or given to the public: fTpCOV ’CA------------------------ <br />I am providing food that is NOT prepared at home: $ Yes No <br />All food is prepared on-site or is from approved commercial facilities: $ Yes No <br />Name of facility: ------------------ <br />“ovlinTX^S^^ <br />dust and the public) <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to <br />areas from the public. <br /> Other (specify): _______________ ________ _ <br />Note. The only operations not required to provide enclosed booths are those which sell 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 />'gj on-site hose bib that is connected to a potable water source. <br /> Other (specify): ------------— <br />bam“p7ovidi^g’an accurate probe thermbi <br />providing the following hot temperature control for the <br /> Sterno & hotel trays <br />Steam table & lids <br />Other (specify);pqppeC <br />' j hazardous food include: ^Se’s. potMosaia-dfeggs, and dairy products.