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Environmental Health Department <br />2. <br />---------Alternate: ( <br />3. <br />4. <br />5. <br />e. <br />connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice. <br />7. <br />8. <br />209464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />ehd ^aze*ton Avenue | Stockton, California 952051 T 209 468-3420 | F <br />06/19/19 Page 7 of 11 <br />'esONo <br />-..-ig: (to protect my unpackaged food and food-preparation areas from flies, <br />r~l rui\ <br />)___________ <br />SWOflOUIN <br />----COUNTY----- <br />’... b'-Aojna-ss :7r,?..- A...-,- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coortiS toree^^s pStotote S*10 'e*™ 3 and eoniP|eted «W of this checklist to <br />1. tNameofEvent.-AZ n^. <br />The following is information about my organization/business: * * ' ‘ <br />Nameoforganization/business: fe J > <br />Mdress: 'ZMf Au. <br />' Phone: ~ £5^ <br />List food to be sold or given to the public: <br />I om providing food that is NOT prepared at home: 0-Ves No <br />All food Is prepared on-sitexrr is from approved cornmeal facilities- <br />Name of facility: <br />Address of fedfity.. T^ke. ^ <br />3du P^d 3 b| W^1 to® ‘ ------------ <br />SSKS" ” ■««-!>" .'SEIS SSE". <br />O Other (specify): <br />approved dispenses, or pJepX^fSfcmXXeKrcS6 ‘h0Se "* bevera9es fram <br />Approved^ drinking, atensll and hand washing «,,, be provteed in my bootb by the « methods- <br />UMpproved bottled water. <br /> On-site hose bib that is <br />O Other (specify):_____ <br />F^nnC^pr0Vide!i formy h00*11'3 U3S: Yes No---------------------------------------------- ----------------------- <br />foods duringairti^S'rfbcEm^pSn-'fflYM □ No"® 810 h0' Snd C°'d h°ld'nS °f Potenlia“Y hazardous <br />am pmvtdmg the followtog hot temperature control for the hot holding of an potentially hazardous foods above <br /> Camp stove Dstemoa hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Q other (specify) <br />N°tS: °f Poten,la"Y hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.