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V*•» i«aai <br />Environmental Health Department <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />b <br />i <br />9. <br />meet*, tamale*, cooked beans, rice, <br />P <br />1 <br />i <br />7. <br />8. <br /> Stemo & hotel tray* <br /> Steam table & lid* <br /> Other (specify) <br />I <br />C <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />0 Approved bottled water. <br />SANJOAQUIN <br />-----COUNTY------ <br />Creornejs grows here <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHO 1M2 P«e« 7 on 1 TEMP EVENT APP <br />0W1V1S <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 Ufil prepared at home: 0 Yes No <br />All food is prepared onsite or Is from approved commercial facilities: 0 Yes No <br />Name of facility ________________________ __________ _ Phone: ( j___________________ <br />Address of facility: ___ I am providing a booth with the following: (to protect my unpackaged food and food^preparationTreas from flies <br />dust and the public) <br />0 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <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: Yes 0 No <br />I am providing an accurate probe thormometor to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Date(s): CH-IS - V5-ZC2J <br />xr,o rwum *8,9ned and oompie,w oopy *checki”,o <br />I.Name of Event: PeAe <br />The following Is information about my organizatlon/buslness. <br />Name of organization/business: Aef <e sec. <br />Address: . 5\\^> K. <br /> Alternate: ) 5^4, - 72 CS <br />List food to be sold or given to the public: PVv xrs (-rcy-qs