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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />include:meats,tamales, cooked beans, rice, <br />7. <br />8. <br />| www.sjcehd.com <br />TEMP EVENT APP <br />SANJOAOUIN <br />COUNTY <br />a potable water source. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />me t"’ S,""1 a signed and completed copy of this cdecklla to <br /> <br /> The fcfcrtng Wonnation about my o^nfeationih^, --------U" <br />Name of organizatiorVbusiness: Inr. <br />Address —----------------- -— <br />Phone: <5P> WbcrW? ' —z------------ <br />' ~ —————--------——------------- Alternate: <br />« food to be sold or given to ttie public. Ftoll pOfflS?/ I^Ctflc. CTlFFt <br />1rzr*9 'ood is pre,,ar8<i a' ^es □ no <br />Name "Mlte »fe "Poroved oommerdat facMes: Ky~ No Cn^ffr <br />Address of facility: ” ------Phone: £-}_____________ <br />dusT^nd th? puWkO 1,16 fo,l0W,ng; (,° Prafect my unpackaged food and food-preparation areas from flies, <br />^a^ning oompletely ^dosin? ^^k^arlas^t S^soT’ PlaStiC' SfrnUar material and fine mesh fly <br />aspha t clean tarps and smooth wood are aSXbl^Id and cteanabl« (concrete <br />areas from the public. acceptable) and constructed to separate food and food preparafon <br /> Other (specify): <br />^oved water for ddnNng. utens. band washing « be pmdded In my bootb by me^. <br />Approved bottled water. <br />Q On-site hose bib that is connected to <br /> Other (specify): <br />Electricity is provided for my booth’s use: frtfYes No--------------------------------------------------------------- <br />I dkrn9 h”timeS of [Tno0'6 ““ hOldin9 °f P°tentially hazardous <br />-m proving the fo.lo.ng hot temperature <br />□ Camp stove Stemo & hotel trays . XfA <br /> Double steamer Steam table & lids <br /> Electric stove top Q other (specjfy) <br />N°te: °f Potentia,,y hazardous food inciuc <br />egetabfes, potato salad, eggs, and dairy products. <br />^HaZe'tOnAVenUe| St0Ckton'Ca'ifornia 95205^ Tf209 468-3420 | F 209464-0138