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Environmental Health Department <br />Gr, <br />Date<s) <br />2. <br />Phone <br />3. <br />4 <br />5.areas from flies. <br />0 Other (specify) <br />6. <br />9. <br />vegetables, potato salad, eggs, and dairy products. <br />i <br />a <br />7. <br />8. <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 /> On-srte hose bib that is connected to a potable water source. <br />Electricity is provided for my booth's use' 0 Yes [^N* <br />I r____________________________, ■ <br />foods during all times of booth operation: (2 Yes 0 No <br />I am | <br />c-?35T;$ Camp stove <br />0 Double steamer <br />0 Electnc stove top <br />Note: Examples of potentially hazardous food Include: <br />O Other (specify):__—------------------------------------------ <br />Electricity is provided for my booth's use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br />0 Steam table & lids <br />0 Other (specify) <br />tS-toS i CVvckx*) LavV-S. <br />IB69E Hazelton Avenue | Stockton. California 95205 | T 209 469-3420 | F 209 464-0138 | vwvrsjgo^o^ <br />. Pa,. 70111 <br />sanjoaquin <br />C o U N1 y <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />tbo (osBvrt coonunafw Ihk^X 'X” to Ihta X'.i'”''<"U'n " <* ,h's chocM*''» <br />’ 1. Name of Even! . 1 < rx V JLUntfcj yrUV iA/ (p/p /^25 <br />following is infomuibon about my organiznlion/business <br />Name of omanizabon/businetw. _V> cl j <br />Across JJUCC CtXcimlLA. Caetv-G <br /> <br />List food to bo sold or given to ih« public: {2x.Vx> C i TH\V'Y<5 <br />I am oroviding food that IS NOT prepared at homo Yos Q No <br />All food is prepared on-site or is from approved commercial facilities Yes No <br />Name of facility 02 P/4<'Phone: (fjU,W ^t^MC <br />Address of facility 4Wl . (SxkkM.CA ) <br />I am providing a booth with the following (to protect my unpackaged food and food-preparation <br />dust and the public) <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and deanabte 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 />meats, tamales, cooked beans, rice.