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Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />meats, tamales, cooked beans, rice, <br />8. <br />1868 E. Hazelton Avenue | Stockton. California ^205JTf 209468-3420| F 209464-0138 | www.sjcehd.com <br />07/3/17 <br />/m,SANJOAOUIN <br />J ------COUNTY'------ <br />Greatness grows 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. / 1 <br /> <br />1 .Name of Event: W Date(^L|Z£A <br />The following is information about my organizatipn/buslness: • ' ' <br />Name of organization/business: P ? I C^|CLi_- 0---------------------------------------------- <br />me e~ ________ <br />Phone: (.QI I ~~ I iC i S Alternate: ( )_ <br />List food to be sold or given to the public:. 'Y))Q-k-\J?4 ferypig-S <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: QXVUO ) Phone: (------1----------------------------------- <br />Address of facility:, -^giuXrlfruc _______,________________3— <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. <br />didst and the public) <br /> A booth with walls and celling 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 /> (xf Other (specify): p p6j.— <br />Note: The only operations not required to provide enclosed booths are <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 />IZJ Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):---------------------------------- ---------------------------------------------- ----------------------------------- <br />7; •■"•"Electricity is provided for my booth's use: Yes (J No --------••7"“ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Tam providing theSriiM^ of all potentially hazardous-foods above " <br />135T: . <br />I | Camp stove [ZJ Sterno & hotel trays <br /> Double steamer EJ Steam’ table & lids <br /> Electric stove lop Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.