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/ <br />SAN JOAQUIN Environmental Health Department <br />1._ Date(S): €4. U, K 2OKXL <br />2. <br />Ci c <br />Phone: <br />J. <br />3. <br />4. <br />uonlH5. <br /> Other (specify): <br />6. <br />my booth by the following methods: <br />9. <br />7. <br />8. <br />,x 11 <br />v.sjgov org/ehd <br />TEMP EVENT APP <br />705 | T 209 468-342: <br />Page 7 of 11 <br />the festival coordinator three (3) weeks prior to this <br />1. Name of Event: CAxy lIoQ <br />a signed and completed copy of this checklist to <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />^lLf°°^V®ndOrS ■(bOth f°r pr0flt and non-profit) are required to return <br />s event. <br />T--' , ...1 I, . j ft■ JCl-r 'Tioh ( <br />foal h cd <br />■ () UXAi - <br />______Phone: (,-1.4 i) ■■ X y-i <br />■foal IX Ca _______ <br />to protect my unpackaged food and food-preparation areas from flies, <br />1868 E. Hazelton Avenue I Stockton. California 9 <br />EHD 16-02 <br />06/19/19 <br /> Alternate: <br />lip 1-t t UflU-'lc .k/ <br />I am providing food that is NOT prepared at home: Wves No <br />All food is prepared on-site or is from approved commercial facilities: ®Yes No <br />Name of facility: [ , , "[ u <br />Address of facility: i \ /■ j kJ <br />I am providing a booth with the following: <br />dust and the public) <br />,0/ booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete7 <br />Xlmme XT” Sm00,h WO°d aC“P,aW9) 8"d <-d8naa„X« XX <br />F 209 464-0138 | w'a <br />D On-site hose bib that is connected to a potable water source. <br />U Other (specify):___ <br />Electricity is provided for my boothduse V Yes No ’"--------------- - --------------------------- -----— <br />' h0, and ”” h°ldi"S O' <br />I am ^providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top 0 Other (specify) CZi < AI bl C <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: I he only operations not required to provide enclosed booths are those which sell beveraaes from <br />approved dispensers, or prepackaged foods from approved sources. ' ‘ Jevera9es from <br />Approved water for drinking, utensil and hand washing will be provided in <br />Kl Approved bottled water. <br />LA 111. I I <br />The follov/ing is information about my organization/business: <br />Name of organization/business: "j , . f \T'-'f L I <br />Address: M r.x■■ j ( s ~j fod <br />(1X ) L Xl Id! <br />List food to be sold or given to the public: 11 \ <br />meats, tamales, cooked beans, rice,