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Environmental Health Department <br />1 Name of Event.1. <br />2. <br />0 ? <br />Address. <br />|Uc<.C-Vv-Os)dAv<\t.s> <br />t3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />® Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9 <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Sterno & hotel trays <br />0 Steam table & lids <br /> Other (specify) <br />a/o <br />) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: H Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />All food vendors (both for P^an^°n^°^ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwwsjgov.org/ehd <br />06H9/1B02 Page 7 of 11 ' TEMP EVENT APP <br /> Other (specify):__ ___________- <br />Electricity is provided for my booth's use: KJ Yes O No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> Other (specify):--------------------------------- ----------------------------------------------- <br />Note: The only operations not required to provide enclosed booths are <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 />SAN JOAQUIN <br />-------COUNTY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />'■) are required to return a signed and completed copy of this check is <br />^vXoXZ'^ P-r.0 this event <br />Y~ Uxk) o ------- <br />The following is information about my organization/busmess: <br /> Name of organization/business: ? v ^.00. <br /> s SAo^ok>- <br /> Phone ( ----------------------- Alternate ( ) — <br /> List food to be sold or given to the public: iAjA i • I- ■*- <br />I am providing food that is NOT prepared at home. 0 Yes [^No <br />All food is prepared on-site or is from approved commercial facilities: Yris^ No <br />,r Phone:];_Name of facility -------------------------------------—------------------— <br />with me Mowing: <«. p-otecl m, unpaged food and (ood-prepamllon areas from died. <br />dust and the public) <br />a A booth with walls and ceiling constructed of either wood canvas, plastic, similar material andmesh fly <br />“eening completely enclosing open food areas. It will also have a smooth and cleanable floor concrete^ <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparato <br />areas from the public. <br />wzl