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s SAN.JOAQUIN <br />1. <br />2. <br />Phone. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />7. <br />8. <br />are those which sell beverages from <br />e -Ts-. '-s,' <br />ehd ?6^2 H^on Avenue ( Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />07/3/17 Page 7 of 11 TEMP EVENT APP <br />Wo, <br />Environmental Health Department <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />szr,o retum a si9ned and compte,ed c°w °f ,ws *» <br /> Date(s). <br />. ., . ., ] i <br />1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: Z.//y> >7 4 5?Av/ <br />Address- -^3^27 SAu/f <br /> Alternate: ( ) _________ <br />List food to be sold or given to the public: ZAr <br />I am providing food that is NOT prepared at home: S'Yes No <br />All food is prepared on-site or is from approved commercial facilities: @ Yes No <br />Name of facility: ------------------------- ----------------------------------------- Phone: { <br />Address of facility:._____________ <br />' and the pubfcf With f0llOWin9: (t0 pra,ect "S' ^packaged food and food-preparation areas from flies, <br />s®relnbinTr7±ipil|tt"d1CeiBr9 cons,™ct®d °f eilher plastic, similar material and fine mesh fly <br />aS cieaXml and °?!2 d are3S " Wi" a'S° have a smooth and cieanabte A00’ (concrete <br />areas fro^ the public acceptable> and constructed to separate food and food preparation <br /> Other (specify):__________ <br />Note: The only operations not required to provide enclosed booths arc <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 />H On-site hose bib that is connected to a potable water source. <br /> Other (specify):________ Electncity is provided for my booth’s use: {3 Yes O No ~ <br />* 1^0HVld,n9 ^..accura/® Probe tbermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: IS Yes No any <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />__Joo r. <br /> Camp stove [J Sterno & hotel trays <br /> Double 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.