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Environmental Health Department <br />Date(s):QClr'1. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />___Phone: £ <br />______ <br />aged food and food-preparation areas from flies, <br />'•r.. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 18-02 Page 7 Of 11 TEMP EVENT APP <br />07/01/2024 <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 />WOn-site hose bib that is connected to a potable water source. <br /> Other (specify): . _________________ _____________________________ <br />Electricity Is provided for my booth’s use: ■Sikes No ~~ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation:^? Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays S <br /> Double steamer Wsteam table & lids ' <br /> Electric stove top '□ Other (specify) <br />S4 booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />SAIWOMUIN <br />------COUNTY------ <br />‘ , Grrornrss qra :i:-. <br />( TEMPORARY FOOD VENDOR’S APPLICATION <br />,0 retum a 8i8"Bd and “ to <br />I.Name of Event:y\KV\\fC/A .^6^^ I <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: 1^17/11/ (A' Cl\ ______ <br />Phone: (31/2 ft-66 Alternate: ( ) <br />Ust food to be sold or given to the public: Wl , 1 <br />I am providing food that is NOT prepared® home: QjYes No —* - <br />All food is prepared on-site or is from approved commercial facilities: Yes No * <br />Name of facility: 9/ VU Rhone: ( ) ^ZLQA^d. <br />Mfixess of fadlity: ^3^ <br />I am providing a booth with the following: (to protect my unpack; <br />dust and the public)