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Environmental Health Department <br /> Date(s): ( 2^ <br />2. <br />Phone:Alternate: () <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />C OUN’V <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />E'SXSEl'SXmXSZas Sr“1 “» » ““ <br />1. <br />Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov.oro/ehd <br />07/01/2024 Pa9e7°,1, TEMPEVENTAPP <br />event. <br />1. Name of Event: fdV/v)M t < K <br />The following is information about my organization/business: <br />Name of organization/business: ~T~Up S L\ <1 ac\C' <br />Address: 2144D s, ueay <br />(7£>^) 47P— <br />List food to be sold or given to the public: <br /> Other (specify): <br />Electricity is provided for my booth’s use: Q'Ves No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: EfYes No <br />' a!P_por°vidin9 ,he following hot temperature control for the hot holding of all potentially hazardous foods above <br />1*35 r. <br />O Camp stove sterno & hotel trays <br /> Double steamer 0Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: □'Yes No <br />All food is preparedon-site or is from approved commercial facilities: [lYes No <br />Name of facility: lAf -rX L-AwuVipvx qp Phone: (7 jy.) — | c, | g <br />Address of facility:^ i-lp C., ^^^7 0 ( rq <br />and the pubfc)1 Wlth the followln9: <to Pro,ectunpackaged food and food-preparaton areas from flies, <br />EreAPni0n0otheom„r?"i i”’'.""9 Cons,;uc,ed of either wood' can™s. P'astic, similar material and fine mesh fly <br />«nh T9; cor"pletely ®nclos|ng open food areas. It will also have a smooth and cleanable floor (concrete7 <br />areas^fromthe pX Sm°Oth WO°d acceptable> and constructed to separate food and food preparation <br />Esther (specify): A TfrVfc <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 the following methods: <br />0 Approved bottled water. <br />□"On-site hose bib that is connected to a potable water source.