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<br />—4 <br />^3 <br />Environmental Health Department <br />Date(s): <br />1. <br />2 <br />Address: <br />cjo) 36V-7/^3 <br />3 <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />a. <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Alternate: ( <br />Doaj L/r5 <br />SAN JOAOUIN <br />----COLlMTY — <br />O 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 />jX Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <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 prepared on-site or is from approved commercial facilitie s: Yes No <br />Marne of facility; ^9/^—i ---------------------------Phone. (--------1 <br />Tam^rov^inga^th with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />’H'A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal arxd 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 />Electricity is provided for my booth’s use: J&J Yes No HrSL <br />I am pravi/dMvj an. aceurafje probe tberwometer to measure the hoi. and. cold heWinu, of poteniiall.y bazardme <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />l^H“el,°nAVenUe| Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjcehd.com <br />Page 7 of 11 1 TEMP EVENT APP <br />U/'df I / <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to -a and—“py <br />. F . Ep p . ------------Date(s): / _ <br />1 Name of Event —‘ ) / ' ------- <br />The following is information about my organization/business: <br />Name of organization/business:-----Be APS <br />E0O 'T~cu,y~i ---- <br />Phone: ( <br />List food to be sold or given to the public:.