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Environmental Health Department <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />9. <br />SAN JOAQUIN <br />COUNTY <br />1- I.Name of Event, <br />2. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />fa ■«“" *ned and onmp,eted c W6 cheeWlsl to <br />EH8D?^2Ha2eltOnAvenUe| Stockton. California 95205 I T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />06/10/10 Pafle7of11 TEMPEmiTAPP <br />0^ <br />The following is Information about my organizatfon/business: <br />Name of organization/business: Pa/p /Ma <br />Address: <br /> Ornate: ( , <br />Ust food to be sold or given to toe puMo: <br />I am providing food tool Is Ifflr prepared a home: ©StosQ No <br />All food Is preparedon-slteor Is from approved commercial facilities: QVes No <br />Na™0,“"y: f MOS-i^Address of fadllly-^r^C^ >/ iw/7 ? ---------- <br />dX^toepS? Ih "’^'towln9: <to PraM "V^packaged food and tod-Xaretton areas from files? <br />Sfe1XX enciSSoZS^M^ P'a* ®|mi*ar material end fine mesh fry <br />asphalt, clean tarps id smooth wood are aSbl 11!1!rnooth and cleanable floor (concrete, <br />areas from the public. acceptable) and constructed to separate food and food preparation <br /> Other (specify):___________ <br />NO,K w“ - ■»"’ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the fdlowlng methods: <br />E^pproved 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: Iff Yes No " ------------------------------- <br />, ','e h0, ““ h0,di"S hazemous <br />^m providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />^Capip stove S^temo & hotel trays <br />^Double steamer Q 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.