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Environmental Health Department <br />1. <br />Date(s): <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />“ --s' " XlsXX' <br />acceptable) and constructed to separate food and food preparation <br />are those which sell beverages from <br />"! ITO 1'8., , <br /><d|n|bL <br />SAN JOAQUIN <br />-----COUNTY------ <br />,i>. Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />“e 10 re,urn a si9ned a"d “mpteted <br />1. Name of Event: KNCDlN cm&F <br />The following is information about my organization/business: <br />Name of organization/business: TO-STQ\ <br />Address: \D W W <br />phone: - tWT <br />'-----^-X------VJ------|------------------_____ Altemategf ) <br />List food to be sold or given to the public^ VA \V S>A V cAP* \ <br />I am providing food that is NOT prepared at homejVl Yes No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No i <br />Name of facility: ph ne <br />Address of facility.^ <br />aSnd S9e (to my unpaekagi, food and tod-prep^atlon nU, ' <br />areas from the public. <br />father (specify): W/ 0^^ <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^ <br />I am providing an accurate probe thermometer to" <br />foods during all times of booth operationMZj' Yes No <br />I Prov'd'n9 blowing hot temperattfrecbi ’ ‘ ' <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of <br />vegetables, potato salad, eggs, and dairy products. <br />3o ------------- <br />reasure the hot and cold holding of potentially hazardous <br />cbntrol for the hot holding of all potentially hazardous foods above <br />O Sterno & hotel trays <br /> Steam table & lids <br />^Other (sPecify)^S^/\|^^^ <br />potentially hazardous food include: meats, tamales, cooked beans, rice, <br />eXoz Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 ! F 209 464-0138 | www.sjcehd.com <br />07/3/17 9 ° TEMP EVENT APP