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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event: Date(s): 7th and 8th June <br />2. <br />Address: <br />Phone:() <br />3.lemonade, pre-packaged baked goods <br />4. <br />5. <br /> Other (specify): Enclosed coffee trailer, IQ'xIS* <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />The following is information about my organization/business: <br />Name of organization/business: Coffee Tree <br />PO Box 64, Volcano, CA 95689 <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />Note: The only operations not required to provide enclosed booths <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 />[7] Approved bottled water. <br /> Alternate: ( <br />List food to be sold or given to the public: Coffee, tea, chai, matcha <br />SAN-JOAOUIN <br />COU N’T’Y <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />are those which sell beverages from <br />pro.^and "on-Profit) ar© required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Watermelon Street Faire <br />EJ On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: Yes 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: Q Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F:Not necessary <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />a™ Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />I am providing food that is NOT prepared at home: [3 Yes No <br />All food is prepared on-site or is from approved commercial facilities: P1 Yes No <br />Name of facility: The Union Inn phone. ( )2092967711 <br />Address of facility: 21375 Consolation St, Volcano, CA 95689 <br />' 3d™ sTandthe public^ f°ll0Win9: (t° prOtect my unPackaged food and food-preparation areas from flies, <br /> 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 />} 5306638000