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EiwironmanW Hsaim Departmert <br />signed and completed copy of this checklist to <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />5- 209 464-0130 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />SAN JOAQUIN <br />COUNTY <br />moats, tamalns, cookori boons, rlco, <br />connected to a potablo water source. <br />a formyhootwi use: B'y^s □ no"--------------------~--------------------------- - ----------------- <br />foods during all tlm^sSboomopSnr'B^ □'no^8 hOt and ““ h0W,n9 of poten,lal|y hazardous <br />™ providing tne following hot temperature control for the hot holding of ell potentially hazardous foods above <br />Etamp stove H^torno & hotel trays <br />Efouble steamer Steam table & lids <br /> Electrio stove top Other (specify) <br />N°,e' <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />aass^srax^-—..--. <br />1- I.Namo of Event: JLe> (2>t-e.X Ti-S A <br />The following is Information about my organlzatlon/buslness: <br />Name oforganlzatlon/buslness: j <br /> <br /> <br />Ph°nS: _ Alternate:( , <br />List food to bo sold or given to the pubilo: <br />I am providing food that is NOT prepared at home: (kf^es Q No vy <br />Z7ofXre^siX^nrXd.crmerclal faclraes: n n° <br /> xsrpubg^^^^ <br />s^^compfiy e^oX^X^ PlaS"0, S'm"ar material and Sna rn03h <br />aspha t, clean tarps end smooth wood are aSab e) andI ™S w ^'n00'h and C,<Wnable fl00r (^e <br />areas from the public. acccptaoie) and constructed to separate food and food preparation <br /> Other (specify): <br />X°Xl3^ those which sell beverages from <br />Approved water for drying, utensU and hand washing wtl! bo provided in my booth by the fo.tow.ng methods: <br />LtMpproved bottled water. <br /> On-site hose bib that Is <br /> Other (specify): <br />EHD ?6-02 Hazel,o:1 Av®nue I Stockton, California 95205 | T 209 468-3420 | <br />06/19/19 Pago 7 of 11