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Daie(s) IZlSis rVM-f 2JX.1 <br />Alternate: ( <br />Wfttt ITlANdvO <br />Mteeo we-xE <br />mwt*, tanwlM, cookad bains, rice. <br />3^ Hazelton Avenue ( StocMon, California 952C«| T 209468,3420 | F <br />SAN JOAQUIN <br />• -....COUNTY- — <br />209 4640138 | www.sjgov.org/ehd <br />TEMPevEKTAPP <br />al) <br />foe festival coordinator three 131 weeks prior to this event. <br />1 Name ol Event 1g.'tOCKT&?1 R-/we tz. VfcTtT <br />The following is information about my organizalion/business <br />Name of organizalion/business: THF S"tC&K.-tCc1 Etar tenm/pAnds VBAAs* <br />Address _PO SOX Ziib 9Toll Ca. C^SOt VEAA^ <br />1------------ -------------- ___ _ <br /> Phone ( Alternate ( ) <br />3. List food to be sofo or given to foe Publie^^^XT^;^^ <br />*. T^Ozen J-nciK-Y iycc--------------------------------- <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: Hyes Fl No <br />Name of facility. <br />,.J —---- -------------------------- -------------------------- Phone-1 )Address of facility ‘---------------------------------- — <br />5 1 X? "9T (t0 <br />are acceptabfe) and constmcted to separate fcodWlXSasphalt, clean tarps and smooth wood <br />areas from the public <br /> Other (specify). <br />Note; The only operations not required to provide enrinwi <br />approved dispensers, or prepackaged foods from approv^ourcZ? berera9es from <br />Approved water for dtinkrng. utensil and hand be prcvfoed In rny txroth by »» fotfo^ <br /> Approved bottled water. <br />EfOn-site hose bib that is connected to a potable water source. <br /> Other (specify): _________ <br />Eiectridty is provided for my booth's use: 0'TesONo '--------------------------------- ----------------------- <br />hot and coki holdfog of potential hazardous <br />ampmvfotng the foilowng hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove rfstemo & hotel trays <br /> Double steamer Steam table & tats <br /> Electric stove top gfother (specify) <br />WO“: <» potentially hazardous food focfoo,. <br />vs9e‘abte«. Potato aalad, egg,, and dairy products. ’ <br />IJ <br />BIS <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />10 re!ljm a copy of this cr.ckiis, to <br />'rS'S ;. <br />1. <br />2 <br />Environmental Health Department