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Environiwintal Hoalth Department <br />TEMPORARY FOOD VENDOR’S APPLICA DON <br />? <br />Address <br />Phoc<o <br />3 <br />4 <br />J__ <br />5 <br />6. <br /> On-s4a hose bib that ts connected tn a potahie water source <br />the hot and ccki homing c# potonb^y hazanton <br />9 <br />vegetables, potato salad, eggs, and dairy products. <br />7 <br />8 <br />SAN I0A0UIN <br />t rmin I y <br />A» food vendors |bo<h lo< pr<X4 and non profit) ant ryqutf»?d to relurn a •ugned and curnp^-cd cop^ < I .i- i r <br />th* feswal o<xx(*nator three <3) P'icm to IM« rrvw4 , ‘ a t . .. <br />,47^,01 MuhcIZ-o-w A 0 ) J <br />1868 E. Hazeton Avenue | Stockton, Calfcina S52061 T 209 468-34201 F 2W 4640138 I •«« hmM.ran <br />Off! 150? Poo* 7* I’ <br />C7WT <br /> Other (specify)------------------ .. —--------------- <br />Electricity is provided tor my booth’s use [vfYcs [ J No <br />I am providing an accurate probe thermometer to measure <br />foods dumg nfl times of ooolh operabon (1 Yes L J No <br />I am providing the foUoumng hot temperature control for the not hokhng of ait potentxafly hazardous -xx-u atz <br />135T: _ <br /> Camp stove Stemo & hotel trays <br /> Doabte steamer Steam table R lids <br />Q Electric stove top EK5ther (specify I C O rh.AAj,z< <br />Note: Examples of potentially hazardous food include: <br />I am providing food that is HOJ prepared al home R O Mo <br />AH food is prapMcd on-site or rt hum approved commr^nal faoMto ! | ! No <br />NnmeoHaoMY ______________________________________P»«* L. <br />f atooto wfo Stowing (to pffiM my unpackagod food and fowl <br />dust and the public) <br />Cl A bnulh with wata and ceibng conducted of eflher wood canvas <br />sSeernng completely endotung open food ara-is It w« also haw a srwdh and <br />asphalt, dean larps and smooth wood aro acceptable) and ennst/udod to war ate food food ' <br />areas from the public <br />meats, tamatee, cooked twans rice. <br />I ho ftjltowwg ra tnforination .itXKif my organwattonflxnrwrts <br />Nantodorganx/aiK^nsms _ I4^X <br />----------- ----------------- ----------------------- <br />QuJC^ ) SS& ~ .3 feJfe._____AJUmurto ^0^ ) ---- <br />Lrtt fowl to be sold or grven to the pirht^ V (4?) 4. _t3.S41Yl ._lp? - CP -L(^* > £iX * f* . <br />IJ Other (specify)__________________——...------------------------------------------------------------------ <br />Note. The only opereltons not required to pravde enctowri booms are those <br />approved dtsponscis, or prepackaged foods f-'om approved sources <br />Approved waler for drinking, utensil and hand washing wi9 be provided in my r.w>?h by the foflowmg meV* ids <br />("'fApproved bottled water.