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4 lie/Date(s) <br />2 <br />v <br />Phone. <br />) <br />3. <br />4. <br />5. <br />6. <br />9 <br />moats, tamales, cooked beans, rice, <br />Environmental Health Department <br />7. <br />8. <br />SAN JOauUIN <br />- COUNTY <br />1868 £ H«sWon Avenue | Stockton. CaWomu 95205 I 1 209 4aa 3420 I f ’09 464-0118 | www8»^^®^pp <br />I Mf> H fji <br />135T: <br /> Camp stove <br /> Double steamer <br />^Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): __________________________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <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 />^^^pproved bottled water. <br />O On-site hose bib that is connected to a potable water source. <br /> Other (specify); __________________________ _ <br />Electricity is provided for my booth's use: K'Yes No <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: H^Yes No <br />I am providing the following hot temperaturecontrol for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />thet° retUm 3 S'9ned and comple,ed copy of th,s checklist to <br />1 1 Name of Event L O f O <br />The following is information about my organization/business: <br />Name of organization/busmess. 'Vl/k’A’4- 5* / <br />Address: ^^^2- \\ |Cr <br />List food to be sold or given to the public. <br /> Alternate. ( <br />I am providing food that is NOT prepared at home: Yes Bfio <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name °f ------------------------------------------------------------------Phone, i_____L <br />Address of facility:_____________ ’ <br />' XSto puWte? Wlth the fOl'°Win9; (t° PrOteCt my unpacka3ed f00d and food-preparation areas from fires.