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Environmei. J Health Depa^n-. <»• <br />_Date(s):'jywwv <br />1. <br />2. <br />3. <br />4. <br />5. <br />which sell beverages from <br />6. <br />8. <br />9. <br />meats, tamales, cooked beans, rice <br />Page 7 of 11 <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />135*F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />- • — <br />A/, <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F <br />EHD 16-02 Page 7 of 11 <br />07/3/17 . . <br />Scanned with CamScanner <br />- q/f/i <br />4>/tV <br />209 464-0138 | <br />SAN JOAudIN <br />------COUNTY------- <br />" TEMPORARY FOOD VENDOR’S APPLICATION <br />1 .Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: <br />__________Alternate: (7( )—-------*----- <br />phone: (707 ’ —-------- ---------List food to be sold or given to the public. f exMtay O <br />I am providing food that is NOT prepared at home:Yes. C] No <br />AH food is prepared on-site or is fwm tone: 00215^222--------------- <br />Name of facility: CV^-Se-----W'aA - C>>a,-u3co . cA 9 11 -------------------- <br />dust and the public) <br />&,r..7s",.r2= z « .n.™ —- p—»" <br />areas from the public. <br /> Other (specify):---------------------------------------------- --------------------------------- <br />Note: The only operations not required to provide enclosed booths: are those <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 />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):------------------------------------- --------------------------------------------------------------------------------- <br />7. Electricity is provided for my booth’s use: Yes ® No . <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazaraou; <br />foods during all times of booth operation: E Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods abov <br /> Stemo & hotel trays - / / A <br />□ Steam table & lids /V/ <br /> Other (specify)