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Environmental Health Department <br />i. <br />2. <br />Phone:) <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />fi. <br />meats, tamales, cooked beans, rice, <br />7. <br />e. <br />S4N JOAOUIN <br />GOUNTY- <br />i35T: <br />OCampstove <br />Q Double steamer <br /> Electric stove top <br />ApV. (O I <br />______ Alternate: ( <br />Date<s): <br />1868 E. Hazelton Averitie l Stockton. California 952051 T 209 468-34201 F 209464-0138 | www.8jcehcl.com <br />EH01S4! TEMPEVENT APP <br />0W1T <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />,o re,um 8 and o,,h,s checkii5''° <br />1. Name of Event. pklV _ <br />The following is information about my organization/business: <br />Name of organization/business: *5 <br />Address: P-QO SVo-Ac C.T. <br />( } H'lC - i-oi -y <br />List food to be sold or given to the public: <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 />I am providing food that Is NOT prepared at home: O Yes OlTo <br />All food is preparedon-site or is from approved commercial facilities: Q^es No <br />Name of facility: Phone: {><1) <br />Address of facility: J-Cyy SYwitet Cl- CA <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparatton areas from flies A <br />dust and the public) <br /> A booth with walls and ceiling 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 />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Approved water for drinking, utensil and hand washing win be provided in my booth by the following methods: <br />O Approved bottled water. <br />O On-site hose bib that is connected to a potable water source. <br />O Other (specify):________ ____________________________________- <br />Electricity is provided for my booth’s use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during aU 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 /> StemoA hotel trays <br />O Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.