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SAN JOAQUIN <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />potentially hazardous <br />9. <br />food include:meats, tamales, cooked beans.rice. <br />7 <br />8. <br />■s/d <br />Environmental Health Department <br />The following is <br />8(->8 F Hazelton Avoihjc j <br />f HD 16 n? <br />0701 .'n,'.i <br />a signed and completed copy of ibis checklist to <br />www Sjtjov )f<vphii <br />TCMP FVENT API <br />Electricity is provided for my booth’s <br />I am providing an accurate probe thermometer <br />I am j <br />135T /VVzi <br />L_l Camp stove ( <br />LI Double steamer <br />1 J Electric stove top <br />Stockton California 95205 | T 209 468-3420 F 20 ‘ .nu 01.3 <br />Page 7 of 11 <br />Da|e(=>: <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />........ <br /> 1 1 Name Even,: cey ZC, <br />information about my organization/business: <br />Name of orgamzation/busincss: - <br />Address Q <br />< //c- > -------------------- --------- Alternate: (^/7 ) - C> Y Q <br />List food to be sold or given to the public^^^Zjg^g HCfc-A4 ✓b O <br />I am provtdmg too.) that is NOT prepared al home: 03^s Q No <br />approved commercial ,acili"es: u Nc <br />Address ol faal.ty /^/j „ ' f 77 <br />XSX) lh° fOl'°W,n9' "° Pr0,“'^a^epb^eashom <br />Xiood IXT n ap,as,ic r —and"V <br />asphalt, clean tarps and smooth wood are acceptable) and nn / a smoo,h f,r,d cleanable floor (concrete, <br />areas from the public acceptable) and constructed to separate food and food preparation <br />LI Other (specify): ___ <br />Approved water for drinktng. utensil and hand wash,ng win be provided ,n my booth by the follow,ng methods <br />i '^Approved bottled water. <br />! J On-site hose bib that is connected to a potable water source. <br />L J Other (specify). _____ <br /> Electricity is prowded fo7my ---------------------------- <br />\ “ “»«“•» <br />. arnprov,d,ng the following ho, temperature controi for the hot hold,ng of at! potentially hazardous foods above <br /> Storno & hotel trays <br /> Steam table & lids <br />C Other (specify) <br />Note: Examples of potentially hazardous f _ ; <br />vegetables, potato salad, eggs, and dairy products'