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ectricity is provided for my booth's use <br />ejther (specify): n/a- iresackaied food <br />I am providing an accurate probe the <br />foods during all times of booth operation <br />I am providing the following hot temperatu ontr <br />4t <br />erno & hotel trays <br />team table & lids <br />her (specify) <br />q5°F: <br />amp stove <br />ouble steamer <br />lectric stove top <br />NiPt - r)qpAca l,t4 61,4 <br />No <br />asure the hot and cold holding of potentially hazardous <br />the hot holding of all potentially hazardous foods above <br />DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />SAN JOAQUIN <br />"WW1 1 <br />REC-008 <br />Environmental Health Department <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 />4th of July 7/4/2024 <br />1.Name of Event: Date(s): <br />The tollowing is information about my organization/business: <br />Name of organization/business: Fab Freeze Fun <br />Address: 18052 Clementine Crt. Lathrop, Ca 95330 <br />Phone: 209-351-1727 Alternate: n/a <br /> <br />List food to be sold or given to the public: Freeze Dried Candy- All Prepackaged Food <br />I am providing food that is NOT prepared at home: Yes' V [lo <br />All food is prepared on-site or is from approved commercial tacilitiesr—Yes-S7No <br />Name of facility: n/a- prepackaged food Phone: n/a <br />Address of facility: n/a- prepackaged food <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 />I;t‘booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and tine mesh fly <br />ening, completely enclosing open food areas. 11 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 />I7Dther (specify): n/a- prepackaged food Ei3 CC) C 1-1L <br /> <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 />Approved bottled water. <br />Tan-site hose bib that is connected to a potable water source. <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, Calitornia 952051 T 209 1168-3420 I F 209 464-0138 I www.sigov.orgiehd <br />END 16-02 Page 7 o111 TEMP EVENT APP 06/19/19