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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />List food to be sold or given to the public: Ad <br />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: lof X'Pf <br />Address: .. 5 | 1 % C <4 Q fy. <br /> Alternate: <br />2u,i<x 5 c______ o <br />I am providing food that is NOT prepared at home: YejJ^^o <br />i on-site or is from approved commercial facilities: YesJ^No <br />------------------------------------------------------Phone: ( ) <br />EHD6®-02HaZeltOnAVenUe| Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 : Pafle/oflt TEMPEVENT APP <br />All food is prepared <br />Name of facility: <br />Address of facility:__ <br />1 A-s’t and the pub “c? Wi'h 'he f0"0WinS: ('° pr0,eC'my u"Packa9ed and food-preparation areas from flies, <br />,0A booth with walls and ceiling constructed of either wood, canvas, plastic similar material and fine mesh fh, <br />screening completely enclosing open food areas. It will also have a' smooth and SSle fcor (concreta <br />areas tom the pSo W°°d 3re acceptable> and instructed to separate food and food preparation <br /> Other (specify):_________ <br />Note: °Perations no1 required to provide enclosed booths are those which sell beveraqes 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):____ Electricity is provided for my booth's use: Yes |Xno <br />' ,he tot and cold h0,dln8 of “y <br />1 pr°'?'d"19 ,he f°"owln9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove QU 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. <br />SANJOAOUIN'Sbq/ —COUNTY— <br />Greofness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to return a signed and c*d checknst to <br />Date(s);JuL 2^^ 2^^7^