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MOW <br /> REC-aot3 <br /> s a N 1 o a u[N Environmental Health Department <br /> Q0 COUNTY <br /> •lyU'ii5;<<��' C�1CU1lFf'p5 y)(Pky1 )I(-IR. <br /> TEMPORARY FOOD VENVOR'S APPLICATION <br /> All food vendora (100111 for prolil Mid 11011-pr,oill) are rc quIred to return a signed and oomplolud copy of this checklist to <br /> isle fesl€val coordinator tivyee(3) wooka prior to this overtl, <br /> . -1-�erYk Dates) June 15, 2024 <br /> 2. The following Is Information about my organlzallon/buslness: <br /> dame of Wanizatlon/business, T (-) - <br /> Address: =C L c_St <br /> Phone: 2 -- Alfemaie: <br /> 3. List food to be sold or given to the public: _H ft <br /> 4. (am providing food MaUkINOT prepared at hom�q"sDo <br /> All food is prepar n-sit r is from approved commercial faclll1le0es3lo <br /> Larne of faG[fhy: �Fhone: <br /> Address of facility: <br /> 5. 1 am providing a booth wfih the following: (to protect my unpackaged food and food-preparation areas from Ilies, <br /> dust and the public) <br /> ;U <br /> king, <br /> 00th with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate toed and lood preparation <br /> areas from the public. <br /> Dther(specify): <br /> Nate: The only operallons not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 8. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> ppr'oved bottled waster. <br /> Dn-site hose bib lhal is connected to a potable water source. <br /> ` Aher(specify);l �.�2 lna St}ny- on our b �vu�ler �-Pr)m7Q 1 P <br /> 7. "MWoity Is provided for my booth's user lye INa t-or.- b1� C-t ""' i <br /> 8. I am providing an .accurate probe the aSure the hot and cold holding of potentially hazardous �-n- <br /> foods during all tlm06 of booth eperatlo e Q <br /> 8. 1 am providing the fallowing hot lemperalu ntr tho hot holding of all potentially hazardous foods above <br /> ramp stova ternQ& hotel trays <br /> oubie steamer Stearn halo &lid$ <br /> 3to <br /> ledricstovelop bihdr(speolty) , u1« <br /> Note: Examples of potentially horardouo food Include: meats, tamates, cooked been rice, <br /> vegelables,polato valad,eggs,and dairy prodU0116 <br /> 1860 E. hfazellon Avenue I Stockton, Gallfornla 952051 T 209 468-3420 1 F 209 464.0136 l www.sjgov,org/ehd <br /> Eltn 4s•112 Pago 70111 . . TEMP EVEW APP <br /> RfidI9119 <br />