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SAN JOAQUIN <br />and norvprofrt; <br />2 <br />Address <br />Phone- <br />3 <br />4. <br />5 <br />6 <br />9. <br />above <br />7. <br />8 <br />Q> <br /><0 <br />Yes No <br />. Phone {____ <br />- Datefsy <br />© <br />F 209 464-0138 | www.sigov.org/ehd <br />’EM? FVENT Apr. <br />"■vgi coonJinatf <br />1 Narm <br />o <br />comosefed copy a' this checklist to <br />|r <br />meats, tamales, cooked beans, rice, <br />Pi. <br />—•••.) following: (to protect my unpackaged food and food ceparaf on areas from ffies, <br />wans and ceding constructed of either wood, canvas, ptasbc, similar material and fine mesh fly <br />asphalt dean X "" 9,50 9 ** ctea^leX^cSXte <br />areas from the publ.c are and constructed to separate food and food preparafion <br />'Xoo,«ismo^) ^>S.A<.C <br />to, *«„ M h„a „ my <br />O Approved bottled water. <br />Q On-site hose bib that is connected to a potabto water source <br /> <br />1 ’’', to' a-a “* <br />I am proving toe fdfowing hot temperature control for the hot holding of all potently hazaroous foods <br /> Camp stove Q Stems & hotel trays <br /> Double steamer ^gSStearn table & lids <br /> E lectnc stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />18 18 E. Hazelton Avenue | Stockton. California 95205 i T 209 468-342P i <br />EH ?$-02 Paget7o111 <br />C6 . ’<£023 <br />Environmental Health Department <br />- - TEMPORAR¥ food vendor s appl.cat.on <br />»»»«w “aor"iB'™ebZ?fe”^X“ <br />Tb _ <br />•™«__ ^4 is | <br /> <br /> > *—"----------~ --------- -- Alternate ( ) <br />O be sold or gwen to the public: <br />Name of faciWy. - S ^^ved commeroal faalifies^ <br /> <br />Address of facilrty: _ <br />‘ DrOVTding a <br />dust ana the public) <br />I—J A booth with v <br />SS"!.. <br />a$Dhaft rtfaan _____ a