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Environmental Health Department <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9.above <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SANJOAQUIN <br />------COUNTY------- <br />G rec r n e s r q r o i v 5 6i <?. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Kd h _________ <br />PG yrwu <br />____ Alternate: (2^> 7) fa <br />are those which sell beverages from <br />Pi?n6?J; Hazelton Avenue f Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.slgov.org/ehd <br />06/19/19 P89e 7 °f 11 ‘TEMP EVENT APP <br /> <br /> <br />if .■■■p- % <br />I am providing food that is NOT prepared at home: j^Yes No <br />All food is prepared on-site or is from approved commercial facilities: [^Yes No <br />Name of facility: _JVU/i/4LLS phone: 77Z. ^3^,3 <br />Address of facility:55 S <br />1 T P/0VLd,i9 a bu.°\h with the followin9: ^t0 Protect my unpadkaged food andfeod-preparation areas from flies <br />dust and the public) <br /> A 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 />areas fromethe pubncand Sm°Oth W0°d are accePtable) and constructed to separate food and food preparation <br />QiOther (specify): fy <br />Note: The only operations not required to provide enclosed booths _ <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 /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):_ <br />Electricity is provided for my booth’s use: Yes [j^JMo '——————------------ <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 S No A <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />135’F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />AH food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. I.Name of Event:A Date(s): p/b <br />The following is information about my organlzation/business: <br />Name of organization/business:// Id j <br />c^) 7^3/673 <br />List food to be sold or given to the public: