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Environmental Health Department <br /> DatR(s): 10/12/2Qg4 <br /> <br />1 Name of Event: H'5?311*0 Ventage mountain house1. <br />2. <br />Address: <br />716-9438)( 650Phone: <br />List food to be sold or given to the public: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 />THMPeVEMTAPPPage 7 of 11 <br /> Sterno & hotel trays <br />•0 Steam table & lids <br /> Other (specify) <br />7. <br />8. <br /> Other (specify):________ ___________ ________ <br />only operations not required to provide enclosed booths <br />The following is Information about my organlzatlon/buslness: <br />Name of organlzatlon/buslness: PupusenaRivera503----------- <br />1629 dover AVE ___ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHD 16-02 * PageTofll TCMPevtMTAi <br />07/01/2024 <br />, SANJOAOUIN <br />I -----COUNTY----- <br />Greotness grutys here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of Ihls ch <br />the festival coordinator three (3) weeks prior to this event. <br />, 308-5623 <br />and food-preparation areas from flies. <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 />^^pproved bottled water. <br />P?6n-slte hose bib that Is connected to a potable water source. <br /> Other (specify):___ <br />Electricity Is provided for my booth’s use: Yes <br />i . ■" „ ‘ <br />foods during all times of booth operation: L <br />I am providing the following hot temperature <br />I^S’F: <br />[VCamp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Alternate: (650 <br />Pupusas <br />.... <br />No <br />1 am providing an accurate probe thermometerXo measure <br /> '■ '■ " Yes No <br />►ntrol for the hot holding of all potentially hazardous foods above <br />I am providing food that Is NOT prepared at home: KYes No <br />All food Is prepared on-site or Is from approved commercial facilities No <br />Name of facility:— Phone: 11 <br />Address of facility:-------------------------------------------------------------------——— <br />I am providing a booth with the following: (to protect my unpackaged food <br />dust and the public) <br />booth with walls and celling constructed of either wood canvas, plasUc similar material andfinemesh fly <br />areas from the public.