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t <br />Environmental Health Department <br />1. <br />2. <br />E^hU ‘Tq.UjCA UL^z <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SAN JOAOUIN <br />COUK-v <br />Note: The only operations not required to provide enclosed booths are <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 />•^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):________ _________ <br />Electricity is provided for my booth's use: Yes □No <br />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: 0Ves No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />(SK^mp stove □ Stemo & hotel trays <br />HDouble steamer Steam table & lids <br /> Electric stove top Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 404-0138 I vww.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />BaA booth with walls and celling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />are h3f ^th" Sni00ttl W00d are accePtabte) and constructed to separate food and food preparation <br /> Other (specify):_____________ <br />. A CHA <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />eTX ,0 8 ™d of this checklist to <br /> I.Name of EventflciiuTAM CfiM Date(s); <br />The following Is Information about my organization/business: <br />Name of organization/business: RiCinri VG <br />Address: <br />Phone: • yi1-^ Alternate: <br />List food to be sold or given to the public: ‘Tft . frrnL <br />I am providing food that is HQI prepared at home: 0*fes No J 1 <br />All food Is prepared on-site or is from approved commercial facilities: Hves No <br />Name of facility:------------------------ ------------------------------------------Phone: (, ) <br />Address of facility: __________________________________________ <br />* ^sCand tl? 3 ^bl?^ th6 fo^owin®' Protect my unpackaged food and food-preparation areas from flies,