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SAN JOAQUIN <br /> <br />Environmental Health Department <br />--COUNTY <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event:3PD Lt-04--1 1-Ar 1,001 C 6.1%) i-tow b4.1ACY-1,65 Date(s): (1/31/2 <br />The following is information about my organization/business: <br />Name of organization/business: ;IQ tieZake--)( tvtail)e---Csfe-X fel-A-4NQ cH P L.-091 - Ciz-61V <br />Address: 1,00(i OA <br />Phone: (5D) 503 0019)9- Alternate: (1/2-0/ ) q9q <br />List food to be sold or given to the public: VA CA-401-0J Qat-Pcf) ,OVz CorpA-.5 wfro-t-P. <br />artez <br />I am providing food that is NOT prepared at home: es 111 No <br />All food is prepared on-site or is from approved commercial facilities:El-Yes El No <br />Name of facility: tAkoe...e locioV6 (6C-tetavit. ppriztc- Phone: (r2) ci53 - gq3°0 <br />Address of facility: II gq K1% ivIACY-e kokl6 2-9 1,0Pi (OA- c151=i'D <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />El A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, 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 preparation <br />areas from the public. <br />211ther (specify): -1.1Cl-0 SC9 cloy,‘ c vett y.AccirleiJ ?eV (PU) <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 />121--kbproved bottled water. <br />a6-site hose bib that is connected to a potable water source. <br />['Other (specify): <br />Electricity is provided for my booth's use: El Yes El No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation:Yes I=1 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 E Sterno & hotel trays <br />Double steamer 121rSteam table & lids <br />111 Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023