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FROM :6:37AM P2FAX NO. <br />12/13/2018 <br />Page <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />Received TimeaA <br />27 <br />7. <br />8. <br />the hot and cold holding potentiaHy hazardous <br />hotdjng afi potenfeliy hazardous foods above <br />Note: Examples of potentially hazardous food mctude*. <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.Sjcehd.com <br />FHO Page 7 ol 11 TEMP EVENT AFP <br />07/3/17 <br />13:05 <br />SAN joaouin <br />... GOtl NT Y- ■■ <br />" “T “*l77 m”’ <br />of Event: <br />.!!5) <br />Environmenta, Health <br />1. 27 2013 <br />foods during all times of booth operation.Yes LJ <br />I am providing the following hot temperature control for the hot <br />135°F: <br />Camp stove I I Stemo & hotel trays <br />r~| Double steamer Fl Steam table & lids <br />O Electric stove top O Other (specify) <br />5 G G> <br /> Other (specify): —--------- -----—---------- <br />Note: The only operations not <br />approved dispensers, or prepacxagwj <br />Approved water for drinking, i— <br />(^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />M To^X'rcpared on-site or is from approved commercial fedlittes: j^Yes □ No <br />r faralitv- b'' A I ‘ ‘-fv ■ X / v— <br />F^oteci Ary u^^od and fooipra^ration areas from flies, <br />dust and the public) <br />wans and “X’ <br />screening, OTmptete^njSh ^ed ^acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />r. 12. -2019, 7:4QAOo. 4921 <br />meats, tamales, cooked beans, rice, <br />w'm <br />kv Zy/Xn <br />M ri/tCte <br />FA <br />Atemate: ( ), <br />pop , <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to ;Gtum a si97y <br />The following is foformation about my organkation/business: <br />Name of organization/business: S <br />Ji Pi.t'.7 b /<o_Av <?.. A-'Z ii'Address: ——-—------ <br />Phone: (^.0 —-‘A ( (~ .A _ <br />List food to be sold or given to the public: 1 <br />food that is NOT prepared at home: Yes ^fNo <br />i on-site or <br />Z-^ <br />te enclosed booths are those which sell beverages from <br />Is from approved sources. <br />hand washins - be p-ovided in my hoah by *. memo*: