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Environmental! Health Department <br />Date(s):1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, lice, <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209468-3420 | F 209464-0138 | www.sjcehd.com <br />EHD 1K02 Page <br />07/3/17 <br />are (hose 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 />Q Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> [Tether (specify): --------------------------------------------------------------- <br />I XX Se hot hazardous foods ahove <br />135°F: <br /> Gamp stove Sterno & hotel trays - * . / <br /> Double steamer Steam table & lids f <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SANJOAQUIN <br />I'4 J-IA l-T ------C O U N T Y <br />'■Y./hiv.''''''' Grcol/icss yrows /iei«. <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 />(he festival coordinator three (3) weeks prior to this event <br /> 1. Name of Event: ------------------------------Datefs): .._O> L 5 <br />The following is information about my organization/business: <br /> Name of organization/business: 1^1 ---------------------- <br /> <br /> (^) 3^2 Alternate: (^ -------- <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: {El Yes No <br /> Name of facility: /■ <br /> Address of facility: I am providing a booth with the following: (to protect my unpackaged food and food-preparation aieas fiom files, <br />dust and (he public) \ . . . ., <br />H 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 sepal ale food and food piepamhon <br />areas from the public. , . <br />[Zf^lher (specify): i'l I ( •> ---------------- <br />Note: The only operations not required to provide enclosed booths