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Environmental Health Department <br />1.Date(s): & 7 <br />2. <br />Qj4 1536/ <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />5 <br />7. <br />8. <br />Name of facility: CcJeI <br />Address of facili <br />1T !? 3 W'th followln9: <t0 protect mV unpackaged food and food'-preparation areas from files, <br />186? E-H^elton Avenue | Stockton. California 95205 | T 209 468-34201 F 209 464-0138 | www.slcehd.com <br />QW?02 Page 7 o(11 TEMP EVENT APR <br />SANJOAOUIN <br />- -COUNTY— <br />tueai/H'1;-; gio . $ /i,-, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />,0 3 Sl0ned and COmPleted °,,hte ““ to <br />1.Name of Event /pgi C>Cajr J- <br />The following is Information about my organlzatlon/buslness: <br />Name of organization/buslness: TTgsZi j Ca.l'Cry^ <br />Addresa: 73^/ Zlui* s/>e. <br />Phone: Alternate: ( ). <br />List food to be sold or given to the public: /ac^^. (&$.« <br />I am providing food that is NOT prepared at home: B'S'es No <br />All food is prepared on-site or Is from approved commercial facilities: 0^es No <br />- — Phone: ) 565—65M_____ <br />st C/4 _____________ <br />dust and the public) “ ' ‘ aiDao "u," ll,oa> <br />booth with walls and celling 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 />aSs from^ie puScand Sm00th W00d are accePtable) and constructed to separate food and food preparation <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 />□^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):____________ Electricity is provided for my booth's use: (3'Yes No ------------ <br />I am providing an accurate probe thermometer: to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation: 0*Yes No <br />1 ^£SvW,n9 the fo,low,n9 hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F: <br />Q3<5amp stove Q Stemo & hotel trays <br />EUbuble 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.