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Environmental Health Department <br />Da.te(s): 1. <br />2. <br />3. <br />4. <br />) <br />5. <br />6. <br />meats, tamaigs, cooked beans, rice, <br />7. <br />8. <br />9. <br />i 868 E.. Hazelton Avenue I Stockton, California 95205 ] T 209 4(58 3420 | F 209 464-0138 | ww.sjceha.co^^ <br />EHD 16-02 Pna.1?. '-?! V <br />07/3/17 <br />7iy organizauoii/uuaiiiesa. <br />_____________________ <br />°i35'5' £ P^Hi e-r AU Afl/urp 95^^_____ <br />(7^ ) Alternate: ( ) <3ID— ? <br />SAN.JOAOUIN <br />r I® 7 COUNT Y— <br />Greatness c/rotvs here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 OA-/W^V / /AA-I- 70'27 > <br />Sm-th^r ___o.M„, <br />The following is information about my organizatipn/buslness: , ( <br />Name of prgariiz.atibn/business; <br />Address: <br />Phone: \ / t/j ; ~ i-------------j-------- <br />List food to be sold or given to the public: N | <br />I am providing food that js NOT prepared at home: Yes. No <br />All food is prepared on-sjte or is from approved commercial facilities: LI Yes H No <br />Name of facility; • i 7..|y_,----------------------------------------- Phone: /------ <br />Address of facility N / i>---------------------------------------------------------—---------- <br />I am providing a booth With the following: (to protect my unpackaged food.and food-preparation aieas from flies, <br />dust arid the public) <br /> A booth with walls and colling 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 arid smooth wood are. acceptable) and constructed to separate food and food prepaiation <br />arqas from the public. . <br /> oto(s^W; <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,•ufonsil and hand washing will be provided injiiy booth by the following methods: <br />LI Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. i <br /> Other (specify): -----------------------------------------------------—------—----------- <br />I botWng BF^ntlal&’hazSrWS tdKI W <br />135T: . I . <br /> Camp stove Sterno & hotel trays <br /> Double steamer steam table & lids /y/7 I c J <br /> Electric, stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables; potato salad, eggs, arid dajry products.