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1. <br />2. <br />3. <br />4. <br />5. <br />Qfother (specify): <br />6. <br />methods: <br />9. <br />7. <br />8. <br />the hot and holdin9 of Potentially hazardous <br />above <br />EHD?6.02HaZeltOnAVenUe| Stockton, California 95205 I T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />06/29/2023 Pa0e 7 of 11 TEMP EVENT APP <br />Q^Stemo & hotel trays <br />’^f^team table & lids <br />H Other (specify) <br />food include: meats, tamales, cooked beans, rice, <br />PuV iMcCuiuyi <br />-------------'---------------------------------Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: H Yes No <br />p-z- ___________-Phone: <br />. . ,H. - -th <br />dusUnd the oubli ? W'th followin9; (to protect my “"Packaged food and food-preparation areas from flies, <br />approved dis jensers, or prepackaged foods from approved sources. <br />Approved water for c rinking, utensil and hand washing will be provided in my booth by the following <br /> Approved bottled water. <br />K/On-site hose bib t iat is connected to a potable water source. <br /> Other (specify): _ Electricity is providec for my booth's use: Yes No ----------------------------- <br />I am providing an rJ ' <br />foods during all tim as of booth operation: Yes No ' ' <br />' ai35P“F•V'din91116 f° '0Win9 hOt control for the hot holding of all potentially hazardous foods <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples ol potentially hazardous f.__' <br />vegetables, potato salad, eggs, and dairy products. <br />I twiroRARY FOOD VENDOR’S APPLICMION <br />JISSXS10 **a si9ned and comple,ed **•*** <br />LXPi yp/IKX at HfcrHTS Date(s), <br />> <br />1. Name of Event: <br />The following is information about my organization/business: <br />Name of organizati m/business: )< 1 XC H GN <br />Address: <br />Phone: ( <br />screeninn constructed of either wood, canvas, plastic, similar material and fine mesh flvaspha" ?ieSTms anJlS areaS’ 11 Wi" a'S0 have a smooth and c,eanable floor (concrete <br />X fromTe pu^ W00d are acceptable) and constructed to separate food and food preparation <br />Wt) -rnucL <br />N°te: liomvidrifer8 nOt reqUir1ed tO pr0Vide enclosed b00tbs are those which sell beverages from <br />aPPrOVeCJ O S )enSArR or nrpnanUoriAd ________-i___ <br />Name of facility: kVM 55 <br />Address of facility: <br />I . <br />dust and the publi:) <br /> A booth with wal s and ceiling constructed of either wood, <br />asphalt, clean tarps and smooth wood