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Environmental Health Department <br />i. <br />2. <br />Address: <br />Phone: <br />3. <br />ft I <br />4. <br />5. <br />6. <br />9. <br />: i <br /> <br />7. <br />8. <br />. - >69209 466-34^* <br />Po<js7 6ft1 <br />1868 E. Hazelton Avenue | Stockton, California£52054 T <br />EMO 16-02 <br /><MQtt2023 <br />foods during all times of booth operation <br />I am | <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially <br />VI <br />a- SANJOAQUIN <br />( —COUNTY— <br />o?’''’ Greotness 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. . . <br />1 Name of Event: -----Date(s): <br />The following is information about my organization/business: <br /> Name of organization/business: 5^0^^ I ' <br />Sfpdic-'hxi, <br />( 2^) Alternate: ( ) ------------------------------------------- <br /> List food to be sold or given to the public: j <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: S Yes No <br />.. .... . Phone: ( ) Name of facility.-—----------------—------------------- <br />“^.ng a’bo^^he fotowing: (to protect my <br />dust and the public) <br /> A. booth with walls and ceiling constructed of either wood canvas. P1^-^^abirHoor^concrete. <br />Zd to separate food and food preparat.on <br />areas from the public. <br /> --- <br />not required to provide enclosed booths <br /> Sier no & hotel trays <br /> Steam table & Ws £ b <br />pother (specify) <br />- hazardous food inciud«i <br />pouto salatf eggs, and dairy product.. . <br />[Vo th er (specify): <br />Note- The only operations not required to provide enclosed booths are those which se» beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />Approved water for drinking, utensil and hand washing win be provtded In my booth by the foUowtng methods <br />Q Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />fSCother (specify)’ fes.sjsaasssssP™.„. „ »«««,« <br />......------ .. <br />iBO ■ <br />beans, rice,