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- <br />SAN JOAQUIN <br />- >. Date(s): <br />I.:' <br />I <br />)Alternate ( <br />3. <br />5. <br />Note: <br />6. <br />9. <br />meats, tamales, cooked beans, <br />| Stockton, California <br />7. <br />8. <br />Bampto, or P«««* '“I*- <br />vegetables, potato salad, eggs, l— <br />OR'S APPLICATION <br />a signed and coveted copy of this checKtlst to <br />M*11 <br />F 209 464-0138 I <br />T«^>i----------------------------------------- <br />---------Jx^Yes No , <br /> <br />pu“> —p«.«-ss.rs‘rra <br />»«;.»»««pW»«»» <br />95205 | T 209 468-3420 | <br />P^jeToitt <br />d <br />r.’ <br />TEMPORARY FOOD VEND' <br /> <br />1 <br />2 <br />Environmental Health Department <br />.e M. - coh «« c< — <br />I am I ......... <br />135°F: i <br /> Camp stove <br /> Double steamer <br /><□ Electric stove top <br />Note: Examples of P®te5Sy, <br />1 Name of Event <br />The following ismfonnation about my organization/business, <br /> N„. .... ...... <br /> —12C--------------- <br /> Phone: ( <tn -— <br />List food to be sold or given to the public.----— <br />I am providing food that is NOT prepared at home. <br />All food is prepared on-site or is from appr---- <br />Name of facility: — <br />Address of facility:—; <br />I am providing a boot!.------- <br />dust and the public) <br />o a »«»».»»•"=—r -ri-fiss s«””« <br /> P“B"e- -^upj.___________________________ <br />® 0,her<sp<’°w: <br />Approved bottled water. <br />□ on-s«. hose «» «is 10 ’ P0“le S°U'“' <br />pmvidin^Jthe following hot temperature....-.- <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />food include: <br />and dairy products.