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r <br /> SA N J IM U I N F nvironft<1efjtRl Ffeafth 17epartmerrt <br /> i FMrORARY FOOT) VFNDOR'S APPLICATION <br /> i{,r fnl;fli•nf rr,r, �'n'^31r"'d to rPlfvn n to aryl r•rs Mrl nVL r0 y <br /> 11,<Inrilvr, qr„s6r'' <br /> �'lr fhic ryttnl <br /> Nr,nr r+1 �•rrH - Il.l{[ DRYI(s) 1 <br /> ' T hr,toflr+win:7 Is rnl4,rmRt nn r�luut my orpAnlfAticx3'tsusirk•aa <br /> Nrvrnri Of(IRIAR,rplgNlrhLlsinF.55 <br /> Addrrt+sr �. .L'.,* .4! <br /> Alternate ( 1b) <br /> 3 1_ist f-d to be sold or given to the public Ur S <br /> a l a prowding food that is NOT prepared at home.❑Yes❑No k^�r4 L-Z <br /> All tood M wepared on-site or is from approved commercial facihties:kYes❑No <br /> Name of tadltty f� Done -L <br /> Address of faciiity <br /> f am providing a booth uv the IEc+wing (to protect my unpackaged food and food preparation areas from flies, <br /> dust and the public) <br /> A b h with walls and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly <br /> sc ing, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> a all,clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> reas from the public. <br /> er(specify): <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 /> 6 Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods' <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): C e-. <br /> 7. Electricity is provided for my booth's use' Yes❑No <br /> S. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑Yes❑No <br /> 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135`F: <br /> ❑ mp stove ❑Stemo&hotel trays <br /> 12 able steamer ❑Steam table&lids <br /> ❑Electric stove top Other(specify) <br /> Note: Examples of potentially hazardous toad include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 F. Nazt-hon Avenue J Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> i I1r:it U+ Pa94 7 of 71 <br /> �x•7::r(r>:, TEMP EVEN7 APP <br />