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Environmental Health Department <br />Date(s): 5-IS- <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br />SAN JOAQUIN <br />COUNTY <br />Greofness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />10 re*urn a and completed ^ °',his checMis' “ <br />1.1. Name of Event: ClxSTbm C)R)5SlCS CRQ SVVOlQ <br />The following is information about my organization/business: <br />Name of organization/business: , V?i6>fs>S <br />Address: <br />Phone: (^C| ) - 5^?^ Alternate: ( ) <br />List food to be sold or given to the public: fabQ PbYtS Ijfl/CSf . <br />I am providing food that is NOT prepared at home: pCYesO No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: MV Sllfc Wfo phone: ( ) <br />Address of facility: L t <41\ r /.\) K.y(, f] ___________ <br /> ' the followin9: protect my unpackaged food and food-preparation areas from flies, <br />uusi anu me puDiic) <br />E-^^1 With yvfllr and .ceilin9 constructed of either wood. canvas, plastic, similar material and fine mesh fly <br />?! ^^P'^'y ®nc,0S|ng open food areas. It will also have a smooth and cleanable floor (concrete <br />areas from foe plbricand acceptab,e) and constructed to separate food and food preparation <br />El Other (specify): V'Qo V ''TTZAifUC-______________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by foe following methods: <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):___________ z <br />Electricity is provided for my booth's use:'K Yes No -----------------------------------------------— <br />1 ,he and <br />’ am Pr°vlding the following hot temperature control for the hot holding of all potentially hazardous foods above <br />IOD i“. <br /> Camp stove .Sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top Q Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />EHD Hazelton Avenue I stockton, California 95205 I T 209 468-3420] F 209 464-0138 | <br />06/19/19 Page 7 of 11