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Environmental Health Department <br />2. <br /> <br />Phone: <br />) <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />( 2099223782 Alternate: ( <br />List food to be sold or given to the public: AguaS FreSCaS <br />www.sjgov.org/ehd <br />TEMP EVENT APR <br />I' <br />SAN JOAQUIN <br />■ COUNTY------ <br />UJ eor«, jjroi.v.*; horw <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />EHD?M2HaZelt0,’AvenUe| Stockton, California 95205 | T 209 468-3420, F 209 464-0138 I <br />06/19/19 Page 7 of 11 1 <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: 0 Yes H No <br />Name of facility: Onsite m <br />P . -------------------------------------------------------------------Phone: ( ) <br />Address of facility: ------------------------------------ - <br />' Zt and the pubT^11 f0"0Win9: (,° PrOteCt my Unpacka9ed f°°d a"d food-preparation are^^T <br />5Ab“th and cojllog constructed of either wood canvas, plastic, similar material and fine mesh fly <br />JnZnf h \W,I‘a,so have a smooth and cleanable floor (concrete <br />acceptable) and constructed to separate food and food preparation <br />screening, completely enclosing open food <br />asphalt, clean tarps and smooth wood are <br />areas from the public. <br /> Other (specify): <br />NOte' th0Se WhiCh 5611 beVera9fiS ftoto <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the foliowing methods: <br />KI 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 KI No ~ --------------------- -------------------- <br />foods during alHim^oTbooth^operation^^Yes and h°ldin9 °f potential|y hazardous <br />1 ^PJ-iding the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Q other (specjfy) <br />Note: °’ potential|y hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1. Name of Event: tk , ■ . 4 Date(s)-^ra— <br />The following is information about my organization/business: ' ZUZo <br />Name of organization/business: Fancysweets_209/Echale Mas <br />Address: