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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />H <br />I <br />4 <br />7. <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />SAN JOAQUIN <br />COUN’v <br />"in b <br /> On-slte hose bib that Is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: D 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: Yes No <br />1 a-|35?F Vid'n9 foMowing temperature control for the hot holding of all potentially hazardous foods above <br />^£amp stove 'JZlstemo & hotel trays <br />^Double steamer Steam table & lids <br /> Electric stove top Other (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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />CfApproved bottled water. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> 1. Name of EventAfate Of A)Date(s) <br />The following is information about my organization/business: <br />Name of organization/business: ftW <br />Address: IaJcz/pv) <br />Phone: (20 Q) fe I <br />List food to be sold or given to the public: ‘h* H <br />I am providing food that is NOT prepared at home: ^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes E^No <br />Name of facility: _____________________iPhone: ( ) <br />Address of facility: _____________________________ <br />1 dutf and the puW?^ 018 fo,towin9: (t0 protect my unPacka9ed food and food-preparation areas from flies, <br />HA booth with walls and ceiling 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 />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify):________________ <br />> (A________________ <br />y /ft <br />Alternate: (2 ) 3 I — C/ 6 G <br />Poo t/