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Environmental Health Department <br />2. <br />Phone:Alternate: () <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />P*0« 7 0(11 <br />7. <br />8. <br />F 209 464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />are those which sell beverages from <br />EHD ?6^2Ha2elton Avenue I Stockton, California 95205 | T 209 468-34201 <br />P*0«7of11 <br />the festival coordinator three (3) weeks prior to this event. <br />1. Datefs): 7 Z" <br />SANJOAOUIN <br />COUNTY------ <br />• GffOlness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />™ 10 a <>"« “"W* “py of eheewst to <br />_ ' r - —irx.*. |IW w«w«i*a <br />1 Name of Event: 0^0 7\ LmJLl <br />The following is information about my organization/business: <br />Name of organization/business: /cjfy? / <br />Address: 7/57/ A^r yc t/V <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: E'Yes No <br />All food is prepared pn-siteqr is from approved commercial facilities: Yes No <br />Name of facility: M- A Phone-( ) <br />Address of facility://// 3 _________________ <br />1 ^us't'and'the pX')h ,he f°' 9 ( pra,ec, my <<nP«l«ged food and food-preparation areas from to. <br />S’toX ouMr S arB ““P*31110' and ppnstructed to separate food and food preparation <br /> Other (specify): ______ <br />Note: The only operations not required to provide enclosed booths era <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 No <br />I am providing an accurate probe thermometer^© measure <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 <br /> Double steamer steam table & lids <br /> Electric stove top Q other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />r i