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Environmental Health Department <br />2 <br />P/tone <br />J3 <br />7 <br />A <br />5 <br />6 <br />I <br />9 <br />f <br />8 <br />Approved water for drinking ulensil imd hand washing will be pro'.’ded in my booth by the following methods: <br />£2^pproved bottled water <br />Noto: The only opcrabcns not required io provide enclosed booths are those which seS beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />13.5’F <br />stove <br /> Double steamer <br /> Electric stove tap <br />!* <br />* <br />I <br />I <br />■ <br />6 <br />- <br />SAN JOAQUIN <br />- -COUNTY <br />Grrotnrjv here. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br /> <br />I bn <br />5I i a 5 <br />- <br />3 <br />16’ 5 i Haze ion Avenue i Stockton, Calif am. ■. 9E20& I T 209 46&3420 j F 209464-0130^ <br />fHD-6 0? <br />0T.«tr?W5 1 <br />AB food vendors (both #cx profit and rxxt prc-frf) are required Io return a signed and complelcxi copy of this checWisf to <br />tl* festival coordinator throe (31 weeks piio to thfes event <br />1 <br /> On-site hose bib that is con.nected Io a potable waler source <br /> Other (specify) <br />Electricity is provided for my booth s use Q Yes QdMo <br />I ami providing an accurate probe dierniometer to measure the hot and cold holding <br />foods dunng an times of booth operation: Q Yes Q No <br />■ . - iSaHy twaMOusloods abc-e <br />:: <br />A <br />mnu, tamalM, coolwdNote: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />r am proving the follov. -g hot temperature control for the hot holding of ail potent <br />fl Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1 Name of EVent F-Ati c€_ <br />The following «s information about my crgamzatton/birsiness <br />Name of organlzaborWlxiSinesfi d5. IrYvdckMan4^' I A HfoXI <br />Address 3^01 M Hfofy y / <br /><3^ > _L33 4-OCA_______ Alternate fit) 3SLjSG <br />List food to be sold cv given to the public _d-aL / (kr-Uu’fA ? ? Df\n.V>S z RxnMu <br />X Prr^A <br />l am proving food that 15 NOT prepared at home £J Yes f I No <br />All food ts prepared on-site or is from approved comnx»fc,tal facilities Yes Q No <br />Name of toeility .1"^v______ Phone PD0}) <br />Address of facility l^oA hl Pl\f3 / <br />I am prowding a booth with ttve fallowrng (Io protect my unpackaged food and food preparation areas from flies <br />dust and the puttfic) <br />1 ] A txxyth with walls and coiling constructed of either wood, canvas p&aslic, similar material and fine mesh tty <br />screening completely enclosing open food areas if will also have a smooth and deanablc floor (concrete. <br />asphaT clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the pubic <br /> Other (specify) _____________________________________________________________ <br />^emially hazardous <br />)rg/«M <br />fvTWTAPP^