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o»>w <br />Environmental Health Department <br />1. Name of Event- 1. <br />Z <br />Address: <br />3. <br />4. <br />5. <br />f <br /> <br />6. <br />9. <br />! <br />I <br />7. - <br />8, <br />The foUowing is infacmaiion about my qfganfeaHan/business: <br />k. a. , 3aint Pete's Bakery Name of organEzabon/buslness:. <br />1849 Orvis Drive, Stockton, CA 95209 <br />Phone: (209)639-5913 Aftemate:( ) <br />List food to be said or given to the public: .Sourdough Baked Goods (Bagds, Bread, Cookies, etc.) <br />Ail food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival cdo.rdrnafortnrae (3) weeks prior to this event <br />Lodi Street Fair© <br />Greatness grows here. <br />TEMPORARY FOOD .VENDOR’S APPUCATION <br />1868 E. Hazelton Avenue | Stockton, California 95205} T 209 468-3420 j F 2094644)138 J WWW.sjceftd.com <br />EHD 12-02. ' Pagp76rii TEME&/ENTAPP <br />07/3/T7 <br />J3®2024' 10/6/24 <br />I am providing food that is NOT prepared at home: Yes jx Nd <br />All food is prepared on-site or is from approved commercial fedliffes: O Yes O No <br />Name of feciHy:Phone: ( 'i <br />Address of fecffify-_______________________________________________—----------------T—_— <br />I am providing a booth with the folfowing: (to protect my unp.ackaged food and food-preparaijcn areas from flies, <br />dust and the puUfc) N7A - Prepackaged Food <br /> A booth with v/alls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, compietely enclosing open food aresst it wifi also have a -smepth end cleanable. fledr (concrete, <br />asphalt, clean tarps and smocrth Wood are acceptable) and constructed io separate food aha. food preparation <br />areas from the public. <br /> Qfoer (specify)^------------------------------------------------------7------------------------------------------- <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 da'nlang, utensil and hand washing wifi be praykfed tn. my booth by frie foilowing methods: <br />Q Approved bottled wafer. <br /> Ofrsife hose bib that is .connected to a potable Wpfor source. <br />Hafer fepaciM: N/A-Prepackaged Food_______________;;____________________ <br />ElectriGity .is provided for my bocthte-use- Yes X Nd <br />1 axn providing an accurate prebe ihermpmedbriQ measure .the and cold holding of potentially hazardous <br /> .foods during all W?s of op^qn: O'Yes' ftq N/A - Frepsckaged Food <br />I smprovidihg the fdllowih'g'h'ot iemperatiire control ibr the hot'htiWins o* an patenttsuy hazardous foods above • <br />"135°F: <br /> Camp sfove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stave top ote (specify) N/A - Prepackaged Food <br />Note: Exarirpfes of poteufiaify hazardous food iricfride: hreafe, 'females-, cooked beans, rice, <br />vegetebles, p.afafo. satacf, ’ eggs,ifany products;