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Environmental Health Department <br />G- <br />1.Date(s) Fncay. May 24th <br />2. <br />Address <br />Phone:( <br />3. <br />4. <br />5 <br />6 <br />9. <br />meats, tamales, cooked beans, rice. <br />1866 E Hazelton Avenue ] Stockton Calrfomia 95205 | T 209 438-34201 F 209 464-0138 I ,wav sjcehd com <br />riMPEvsnL’/rJ'b TEMP EVENT APP <br />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY------ <br />(nett <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is information atxxit my organization/bussness <br />Name of organization/business Garneday Grill <br />306 Rich Bar Ct, Roseville CA 95747 <br />s sr10 ,a,m 3 am “n'p,e'M “w ’* chK*"a “ <br />1 Name of Event Kaiser Stockton Lunch <br />Note: The only operations not required to provide enclosed Booths are those which sell beverages from <br />approved dispensers or prepackageo foods from approved sources <br />Approved water for dnnking utensil and hand washing wdl be provided in my booth by the following methods: <br /> Approved bottled water <br />I am providing food that >s NOT prepared at home Yes 0 No <br />All food is prepared on-site or is from approved commercial faairties. 0 Yes O No <br />Name of facility Capitol commerce ________ Phone ( } 273-0946 <br />Address of facility 320 North 10m Street Sacramento CA 9581: _______________ <br />I am providing a booth with the fottowtng (to protect my unpackaged food and faod-preoaration areas from flies <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood canvas plastic, similar matenal 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 />0 Other (specify) Mobile Food Facility <br />j 916-273-0946> —----------------------------------------------Alternate. ( ) <br />List food to be sold or given to the public: Burgers Chicken sandwiches, Th tip leaned fries <br /> On-site hose t?ib that is connected to a potable water source. <br />0 Other (specify; Water tanks on the mobile food facility <br />Electricity is provided for my booth s use 0 Yes No ' <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation: 0 Yes No <br />1 providing the following hot temperature control for the hot holding of all potentially hazarrinus foods above <br /> Camp stove Sterno & hotel trays <br /> Double steamer 0 steam table & lids <br /> Electric stove top 0 Other (specify) grj{| <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.