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Date(s): .7r^£- <br />1. <br />2. <br />Address <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />1868 E. Hazelton Avenue I <br />7. <br />8. <br />Environmental Health Department <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 /> Sterno & hotel trays <br /> Steam table & lids <br />gl Other (specify) W&jt- <br />potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> On-site hose bib that is connected to a potable water source. <br />IS Other (specify):14^—3— --------------------------------- <br />Electricity is provided for my booth's use: C] Yes Q 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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of <br />vegetables, potato salad,”eggs, and dairy products. <br />• T '"‘OO V?-* ri-l'TO I . n-,-, . O f,- - <br />sanjoaquin <br />■ county <br />G TEMPORARY FOOD VENDOR'S APPLICATION <br />..... <br />lh.ee (3) wee. pho, to th.s event <br />, Name of Event -1? ------------ <br />The following is information about my organization/business: <br />Name of organization/business: <br />VlA^L— <br /> I Alternate: ( r1 <br />Phone (<3DA ) 21 -PP-C------------------ - <br />List food to be sold or given to the public: ------------- <br />I am providing food that is NOT prepared at home: ® Yes No <br />All food is prepared on-site or is from approved commercial facthttes.^ e □ <br />Name of facility: ------------------------- ----------------------------’ <br />Address of facility:,.--------------------- --------------1 mnarkaaed food and food-preparation areas from flies, <br />I am providing a booth with the following: (to protect my unpackaged <br />dust and the public) <br />KI A booth with walls and ceiling constructed ofeither cleanable floor (concrete, <br />^^aTcieX^ps'andXth Xd are acceptable) and constructed to separate food and food preparation <br />areas from the public.