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Environmental Health Department <br />/kg1.ua)Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />^71 nA [\Xaryij <br />1.0 ftA- Vgvi Si. gM <br />meats, tamales, cooked beans, rice, <br />HaZeltOnAVenUe| StOCkton'Ca,ifomia9520p53l 7J09 468-3420 | F 209464-0138 | www.sjgov^g/ehd^ <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: ,S Yes No <br />Name of facility: -----------------------------------------------------------------phone; { <br />Address of facility: ____ <br />' XTandtte pubite)1 Wi‘h the f0"OWin9: (f° Pr°teCt my unpacka9ed food and fo^-preparation areas from flies,' <br />[SA booth with walls and ceiling constructed of either wood, canvas, plastic similar material and fine mesh flv <br />aX7deannJaP™ a ®nclosl"9 opea food areas- 11 also have a smooth and cleanable floor (concrete <br />aX from the puMc aCCeptable) and “"structed to separate food and food preparation <br /> Other (specify): _____________________________ <br />N°te: looroved XTtiOnS nOt reqUiTd t0 pr°Vide enClosed booths are those whioh se|l beverages from <br />approved dispensers, or prepackaged foods from approved sources. 9 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />S Approved bottled water. <br />B On-site hose bib that is connected to a potable water source. <br /> Other (specify):__ <br />Electricity is provided for my booth’s use: 0 Yes No------------------- -------------------------------- - <br />' ^od^s^uring a^Ptim'es'oTbooth^operattere'H^es1 n^o111^6 b0'*"9 °f P°tential,y haZard°US <br />1 a™'d'"9 ‘he following hot temperature control for the hot holding of all potentially hazardous foods above <br />E Camp stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) e <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SANJOAUUIN <br />-----COUNTY- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event: ^C~k\ n~V KIqH/ 'S /zi Mi ly <br />The following is information about my_organization/business: <br />Name of organization/business: mA /IsS L//^^ <br />Address; ^^3---n^Acrvi Sv, <br />' Oho I Alternate: (709 ) <br />List food to be sold or given to the public: ' /ll vUgl-cJ