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Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />1. <br />2. <br />Address: <br />3. <br />4. <br />_ Phone: (I <br />5. <br />iged foods from approved sources. <br />6. <br />hat is ci <br />9. <br /> s <br />meats, tamales, cooked beans, rice. <br />7 <br />7. <br />8. <br />screening, completely enclosing open <br />asphalt, clean tarps and smooth wood <br />areas from the public. <br />SAN JOAQUIN <br />— county---- <br />Apjjroved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ApproVedbotiled waler. <br /> On-site hose bi <br /> A booth with walls and ceiling conslfucted of either wood, canvas, plastic, similar material and fine mesh fl <br />•- - - j ood areas, it will also have a smooth and cleanable floor (concrei <br />ire acceptable) and constructed io separate food and food preparat® <br />aicoo iiwin urs puwtrv. ft' <br />Oth^^peciM: <br />Note: The only operations not required to^^ide^enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Yes No <br />icmhometer to measure the hot and cold holding of potentially hazardous <br />■Tbqn: Yes No <br />control for the hot holding of all potentially hazardous foods above <br /> Si erno & hb^l trays <br />earn table & litte <br /> O her (specify) \ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Phone: <br />Li>l food to be sojd or given to the publii <br />I am providing food that is NOT prepared <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility. <br />Address of facility: <br />I am providing a booth with the foliowind: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />1. Name of Event: T <br />The following is information about my oiganization/business: <br />Name of organization/business: <br /> Alternate: (—T-----' <br />inacted to a potable water source. <br />D Other (specify): V11 <br />Electricity is provided for my Mfci use <br />I am providing an accurate probe'tqc <br />foods during all times of booth oper^bqr <br />I am providing the following hot temperati <br />135T; <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />X .his Sred 10 return a signed and compleied copy of **checldisl 10 <br />1868 E. Hazelton Avenue f Stockton. California 95205 | T 209 468-3420! F 209 464-0138 I www.si <br />EHD 16-02 Pago 7 of n J <br />07101/2024 x I I