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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7, <br />8. <br />HaZ0’ton Av0nue 1 Slock,°n. California 95205 | T 209 468-3420 | F 209 4644)138 | www.sjgov.org/ehd <br />06/18/19 1 TEMP EVENT APP <br />SANsJOAQUIN <br />------COUNTY------ <br />Grpotness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />wXSto ra,Um a RSn6d Bnd COmPteW “W *th,S “* <br />1. Name of Event: C^£> <br />The following Is Information about myorganlzatlon/buslness: <br />Nama of organlzatlon/buslness:. <br />Address: <br />Phone: Alternate: ( ) <br />List food to bo sold or given to the public: <br />I am providing food that Is NQI prepared at home: D No <br />; ± <*?. Address of faculty: ~ <br />1 ^asndhe puMta)' '"lt’1 lhe Wtwln9: <to Prol“c‘m/ unpackaged food and food-preparation areas fran fliBs?' <br />TO^hohcnmrJ^and °f el,ller w0°d' camas. P'3^, similar material and line mesh Uy <br />asnhan dflpn tSnl V ^nc,osi^ ope" food areas- 11 Wl11 also have a smooth and cleanable floor (concretey <br />areas fro^X piblic Bccept0b,0, 8nd “"^cted to separate food and food preparation <br /> Other (specify):___ <br />NOt°: I™^2^t,OnS nOt reqU,?d t0 zprovide enclo80d boo{}ls 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 /> On-site hose bib that Is connected to a potable water source. <br /> Other (specify): ___________ Electricity Is provided for my booth’s use: (PT Yes No -------------- <br />1 P?be thermom^,or!neasure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation: Bves No y <br />' a|35PpV,d,n9 th®follov/ing hot temperature control for the hot holding of all potentially hazardous foods above <br />pf’Camp stove Q stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top 0^er (specify) , <br />Note: Examples of potentially hazardous food Include: meats,Gamales, cooked beans, rice <br />vegetables, potato salad, eggs, and dairy products. 1 <br />Date(s):.