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Environmental Heaith Department <br />2. <br />3. <br />4. <br />5. <br />pther (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />wrais <br />yzircnr. <br />SAN JOAQUIN <br />COUNTY <br />a4 HazeltOn Avenue I stockt°n. California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjgov.org/ehd <br />O7/?i)26o“ Page 7 of 11 TEMP EVENT APP <br />OCTO <br />Date(s): <br />signed and completed copy of this^heckEsUo- <br />y Yes Q No <br />l0n^! Y t0 geasure the hot and cold holding of potentially hazardous <br />cbntrol for the hot holding of all potentially hazardous foods above <br />Sterno & hotel trays <br />»team table & lids <br />Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 1 Name of Event M Gift V V IfVIP ft bl fHI <br />The following is information aboutmy organization/business: <br />Name of organization/business:mw ict CFenm no <br />IWIS WIMiNblON OftKHil Lf CMlWI <br /> Alternate: ( ) <br /> <br />I am providingfooS ffat^IlOTprepSredanroffiJkMsHZ] No <br />All food is prepared on-site oriisi fromlapprqvedco Jmfercial fecilities.ljfc Yes QNo z. » ZA r> Zi <br />Name of facilityXOHllN^NlHL j (E Cls-BlffiW , “Phone:?.2^' 2-^7 V ^lO^T / <br /> dus^and^the public)1 "‘b foll°wl"s (‘o pr°tect m^npac’aged food and food preparation areas from flieT^1 * <br />£reAeninohrnmnSr const?cted °f either wood, p^vas. plastic, similar material and fine mesh fly <br />asS ciean raml and" °Pe2 f0°d areaS' 11 Wi" a'S0 have a sm00,h and cleanable n°°r (concrete <br />areas from“ e puMc acceptable’ and constructed to separate food and food preparation <br />hflofoiie foot) hficiuTY. <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 />weeiorvwWl <br />^Other (specify)UTf 1^1 I N F ■ <br />7. Electricity is provided for my booth’s use:"*’ ‘ - -------------------------- <br />8. I am providing an accurate probe thermc.. <br />foods during all times of booth operation:' <br />* am providing the following hot temperatun <br />□ Camp stove <br />^Double steamer <br />‘O Electric stove top