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I <br />EwBro^m®rtaB HealJtt Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, conked beans, rico, <br />7. <br />8. <br />9. <br />ehd ?6^2 P,azelton AvGnue I Stockton, California 95205 | T 209 468-3420 | P 209 464-0138 | www.sjgov.org/ehd <br />00/18/19 Page 7 of 11 TEMP EVENT APP <br />SAN JOAQUIN <br />COUNTY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />tafesfc Sworitt thXm(3)XksX tn *hi= ST'110 r6fum “ 8lBned and C°"’P|B'«' “py <* checklist to <br />Utame of Event:. '< Da^._/I . <br />Thb following is information about my organlzatlon/buslness: <br />Name of orflenlzatlon/bu8lnae8:~7flfj5 Pa^/iHa _________ <br />AddrssB: ^pc io c/f- <br />PhLe: Alternate^ ) <br />List food to be sold or given to the public: <br />I a(n providing food that Is NOT prepared at honteJ^sDNo ' 'F^ <br />All food Is preparedon-elte or is from approved commercial facilities' BYes No <br />Na™ °f Phone: ^ff-5-^Zf <br />Address of faolllty^y Tope U bf 45367 —— <br />a<SsPt and theapubb°fc)h ,he^“Owl"8: (t0 Prat8cl^npackaged food and food preparation areas from flies, <br />eXnlna compSlv endSoS^areAa"1 a T',’ “T88'PlaStl0' 8'm"ar ™,arlal and me8h "V <br /> Other (specily): ~7^g,/gr ‘ <br />Ap roved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />E- 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 No —------------- -------------------------------------------- <br />thB hot and “I* ha«'n8 of potentially hazardous <br />' aj^,dln®thB followm0 hot fomperature control for the hot holding of all potentially hazardous foods above <br />j ^apip stove ' . oierno & hotel trays <br />Rouble steamer steam table & lids <br />Eleotrlo stove top other (specify) <br />No e: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.