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REC-008 <br /> SANAOAQUIN p <br /> Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vEixbrs .both for profit and non prolif) are required to return a signed and completed mpy of this checklist to <br /> the iesbval coordinator tiree;31 weeksLrior to this event. ' <br /> 1. 1.Name of Event. �� (� L�l�ll _ Dale(s) q/-7 <br /> 2. The following is information about my rxganizaf onbusiness: <br /> Name of organizatimbusiness: Heavenly Ice <br /> Ads: 17562 Capricorn Ct, Lathrop, CA 95330 <br /> Phone: 206-853-3873 Morrow. 925-339-4459 <br /> 3. List food to be sold or given lo the public: Italian ICe <br /> 4. 1 am providrTg trw d that is ITT prepared at hcmeV�SS Do <br /> All food is prepared on•sde or is from approved commercial taciidies e o <br /> game of iac.00: Stockton Community Kitchen Phone: 209-608-5455 <br /> Address of lacility:110 N EI Dorado St, Stockton, CA _ <br /> 5. 1 am provi,ding a booth with the tolfowing:Ito prdecf my urpadkaged food and food•preparabori areas from dies, <br /> dust and the public) <br /> booth with wails and oiling consbucx�d of either wood. canvas.plastic. similar maleri al aria tirte mesh fly <br /> ing, completely enr_.Irsing open food areas It will also have a smoott7 aw. clEanablc• floor tconcreic, <br /> asphalt. clean tarns and sm olh wood are acceptable)i and constricted to separate food and irsod preparation <br /> faarreaas from lir m the pub <br /> fir. <br /> _ _. (sp`'oV i <br /> NaAr. The only operations not requred to provide enclosed broths are rhos* which sell beverages "rem <br /> approved dispensers.or prepackaged foods from approved sources <br /> 6 Approved water for drinking. utensil and hand washing will be provided in my booth by the flowing methods <br /> E4pproved bottled water. <br /> —W n•site hose bib that is connected to a potable_ vwa1vr s,,rcr_ <br /> 7 ��:tyl`is provided for my booth's use NO <br /> 6 1 an providng an accurate probe th_ sure the hot and ald h-Adiim rJ poentially hazardous <br /> tools during al times ri booth operatirXr o <br /> 9 1 am providing the lr.Alwinq hot to n, tr9IJ <br /> the hot holding of all pate-MiAl y hazardous ioods above <br /> — 1 5°F. <br /> stove F 51emo& hotel 'rays <br /> uble steamer Steam table 8 lids <br /> Ic r_.trir gyrve"DC, ?lhrr '_ It <br /> =pee x) <br /> Hole: Examples of potentially hazardous food include: meats, tarnstcs, coa*Cd brans, rice, <br /> YeVetabfes.potato salad.eggs,and dairy products- <br /> 1868 E. Hazelton Avenue i Stockton.Cakirxnia 95205 T 209 468-3420 1 F 209 464 0138 I www.sjgov.org'ehd <br /> Be 1602 Pw?d 11 TBV EVF#r/PP <br /> OE.'14�3 <br />