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Environmental Health Department <br />2. <br />So-15 <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />ELecrrio WAfZM'MOj O/'tViNtq' <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />-COUNTY----- <br />Date(s): ^"5 <br />^?MiHa^O,tO^AVOnUe, Stockton. California 95205 | T 209 468-3420 | F 209464-0138 | www.sigov.ora/ehd <br />07/01/2024 p*9® 7 of 11 TEMP EVENT AFP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival to th™ Mnl™*10 ™,lJm 8 S,BnBd 8nd completed “PV °f this checklist to <br />1 1. Name of Event: ?i?<rtpK-1n <br />The following is Information about my organization/buainess: <br />Name of organization/business: JV C \ V>y 9~j~ <br />Address: 44^ P-D SroolcroiJ <br /> < Alternate:( )_ <br /> List food to be sold or given to the public: 6 QZ. SOM PfV TZgJL 'SfiCKS LO) <br />I am providing food that Is NOT prepared at home: Yes^] No <br />All food is prepared on-site or is from approved commercial facilities: El Yas No <br />Name of fadifty: _gonfiG,E ^OOO (207) ^1,-37^0 <br />Address of facility.^ MH 15 FAQM lNuTON A 5^^ <br />dust and fre public)1 W*th thB fo,lowing: (to protect my unpackaged food and food-preparation areas from flies, <br />^nl^^MX^rlS °f either wood' canva»' P'a8ta' 8im,lar mate™' and *"6 mesh fly <br />asphalt clean taros and JXth foOd area8” K Wl11 a,S° havo a smooth and cleanabte floor (concrete, <br />Xs toe pibHc acceptabte) and constructed to separate food and food preparation <br /> Other (specify):________________ <br />Note; The only operations not required to provide enclosed booths are those which sell beveraaes 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 toe following methods: <br />(^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): Electricity is provided for my booth’s use: Yes No " <br />® nT™,he h0'and ““h0Winfl °f <br />' the lowing hot temperaturfbontrol for toe hot holding of all potentially hazardous foods above <br /> Camp stove Q stemo & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top Q other (specify) <br />Note: Example* of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.