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MVT I VOsJ/p. 1 <br />Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />64 <br />7. <br />8. <br />SAN.JOAQUIN <br />-----county----- <br />www.sjcehd.com <br />TEMP EVE NT APR <br />orpreJackagStfl°Se Whicb 8611 beverages from <br />I. utensil and hand washing wi« be provided in my booth by the following methods; <br />ue| Stockton, California 95205 ) 7^209 468-3420) F 209 464-0138 J <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the ^®s®vaf coordin^orthree'cs) wroks pitor^tofe event5^ 10 3 and comPJeted copy of this checklist to <br />’■ _____D^,: <br />owing is informartion about my organizatiorVbusi ness: <br />Name of organization/business: f <br /> <br />Ph°ne: ~ <br />I am p.wding >hat a p<^red „ T <br />aPOn>>“ BTes Q Nc S ' <br />Address offadfity: “ ----------Pbone: I--------1_____________________ <br />dust and frw pi^bfc)1 faUow,nS (to protect my unpackaged food and foodpreparatron areas from flies, <br />screening, compfetefyo^nfo^d P*aStiC’ materia’and fine mesh fly <br />aspha^ean terPs ar,d ^th w!rod SeJSbia^d and deanabte ««* (concrete <br />areas from the public. acceptable) and constructed to separate food and food preparation <br /> Other (specify): <br />Note; The only operations <br />approved dispensers. <br />Approved water for drinking, <br />EfApproved bottled water. <br />0 On-site hose bfo that is connected to a potable water source. <br /> Other (specify).- <br />provk,®d my booth’s use: 0 Yes ---------------------------------- -- ----------------------------------------- <br />1 ** h°Winfl P0*6"^^ hazardous <br />,f he following hot temperature control forthe hot holding of ail potentiaHy hazardous foods above <br /> Camp stove q & hote| <br />□double steamer O Steam tabie & fids <br /> Electric stove top Q Other (specify) <br />NOte: Of P‘rten«aBy hazardous food include- <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Aven <br />EHD 1BO2 <br />J7/3/17