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of (Ills checklist to <br />1. <br />2. <br />) <br />3. <br />4. <br />K)]|x 6. <br />9. <br />meals, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />SAN JOAQUIN <br />c. Ol IN' V <br />1868 E. Hazelton Avenue | Stockton, California 95205^ 1^209 468-34201 F 209464-0138 | www.sjgovjxg/ehd <br />OBH6/19 <br /> Other (specify): ------------------------ -------—==—--------------- ------------------- - <br />[mtalhomHolw to moosura tho hot and cold holding of potentially hazardous <br />I r^roS Hw Ute hot holding of all potentially hazardous foods above <br />135*F: <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />Environmental Health Department <br />Ml A 5. <br />OR'S APPLICATION <br />n signed etui copy <br /> Other (specify):------------------------------------------------------------------------ <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-site hose bib tital Is connected to a polable water source. <br />7. <br />8- <br />N>lk <br />temporary food vend <br /> <br />1. Name of Event: „.1 CsJi— <br />The lolk.wi.tg is Information about my oronnl/nlio.Wl.usInoss: <br />Name of oiyanLrattoiVbusIness: — <br />Address: <br /> Phone: ( ---------- Alternate ( <br />List food to be sold or given to tho public:-----— ---------------------- - <br />I am providing food that is NOT prepared at home; 0 Yes No <br />Afl food is spared on-site W is from approved commercial fadlrties: <br />Name of facility: G<m~^ T~~ <br />Address of facility: SA. -z-Crf f 6^, food and food-preparation areas from flies,I urn providing a booth wrth the following: (to protect my unpackaged food and looo-pro, <br />dust and the public) .-■?—.4.-—7-r— <br />• - □ A booth with watte and ceHteg 01 orth<* ^^oth"^! dX^to floor (concrete, <br />aZU) and co«i to separate food and food prepared <br />areas from the public.