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8:03PMFROM :FAX NO.8 2013 P2L9- <br />Environmental Health Department <br />i. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />O Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />PageToTII TEMPEVEMT APP <br />Received Time Ap r. 24. 201 9 9:06PM No. 4957 <br />Date(s): IM <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />k|] Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <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 />\ SANJOAQUIN <br />‘ \ COUNTY-— <br />Grcotncn here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E Hazfltnn Avenue I Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjcehd.com <br />eHOi&ai PagoTrfii <br />07007 <br />All food vendors (both for profit and non-profit) are reouired to return a signed and completed copy of this checklist to <br />the festival coordinator ^6^) <br />The following is information about my organization/business: <br />Name of organizationfousiness: <br />Address: ljO£\ CCkWUnfr QA PlST./4) <br />( '7^0O'Z^-______________ Alternate: ( 2.0*1) ljU S O <br />List food to be sold or given to toe pubfic: ICC CX-CGW\. <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify):___ <br />Electricity is provided for my booth’s use: ®_Yes O No <br />I am providing an accurate probe thermexneter to measure the hot and cold holding of potentially hazardous <br />foods during afl times of booth operaton: ^-Yes No <br />I am providing the fofowing hot temperature control for the hot holding of afl potentially hazardous foods above <br />135^: <br /> Camp stove O Stem© & hotel trays <br /> Double steamer D Steam table & lids . <br /> Electric stove top {frother (specify) Y\0 XcA1 ^000-5 <br />I am providing food that is NOT prepared at home:^-Yes Q No <br />All food is prepared on-site or is from approved commercial fadflties: ^-Yes □No <br />Name of facility: Svmxv \T\na\________________phone:(2<f!) AST. -ig2O <br />Address of fadHtvrl^ MO- MCrfvvNar Lf\ <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />booth with waHs and ceding constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas, ft wifi also have a smooth and deanable 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 />t.’. i- A-