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Environmental Health Department <br />2. <br />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 />7. <br />8. <br />SAN JOAOUIN <br />------COUN~Y------ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />;evqentred ,o ^c“sv° <br />1. 1. Name of Event: <br />EHO In? Hazelton Avenue I stockton, California 95205 I T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />06/19/19 Page 7 OM 1 TEMP EVENT APP <br />Phone: J?/,?) 60.^6 <br />List food to be sold or given to the public: V-\- <br />--------Date(s):%) KWi.-'Ll - <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: C< <6jL <br />_ Alternate: ( ) <br />RCi; fl - ge./vs <br />I am providing food that is NOT prepared at home: j^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes^No <br />Name of facility: Phone; { <br />Address of facility: <br />1 TusTandthe pX? f0"0™9'(t0 Pr°leCt my unpacka9ed food ^d food-preparation areas from flies, <br />BeAeninnlhcnm„^,lr .“•"h0 const~c,ad of either WQOd' camas- P'^tic, similar material and fine mesh fly <br />aS 7 a °Pe? °d areaS- " Wi" als° have a smo0"1 and cle3nable "oor (concrete <br />fromT and Srn0° h W00d are accePtable> and constructed to separate food and food preparation <br />aiv7cis ironi me puoiic. <br /> 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 />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />1 a™ Po1?^'09 the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F: <br />Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.