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<br /> 61k?6, 12.39 PM 1000006372 pq
<br /> . SAN JOAQUIN r~�I1VIY('•llit4i:tit�.tl rt�>`�i�tr� �.)c;��t:tltri►e�i�.
<br /> {-0LaNTY
<br /> TEMPORARY FOOD VENDOR'S APptrICATION
<br /> r f this r,l;r c.kllst to
<br /> f AU fr1W vendors Sb0 IN p;ufif and non•prilflt}fire TRgUirM to rr+torn n flrS IA(I and i 1101ii1E'lPLI copy� `1
<br /> h bete "Val Wordh3ator three(3)vverl<s poor to1III; vent,
<br /> NPrT�tdF,vtmrt J.(1�..
<br /> i_ The WkAWINI iB,nfomlation about my t,"gar117?tlr+1)11)U�-��"��
<br /> Name of organizslrien7t?�isine:ss._ .��'. 1.!0. � _._0U ri Gili --- ---- ----
<br /> Ll`s'food to be sold a`given to thrr txit brr - _�lrl r�l r ���Utt
<br /> 4 1 an,providing fuod',11j;:Is NOT p+ 1 :1 :;' ,r A`' ti r j-. �,',;,
<br /> All food is prepared on-site or}s fran;aI1Fruv-:td,:;lnf11}ercral faci'ilies: ❑ yes( j i:c,
<br /> Name of irrcility —
<br /> phnllr ' 1
<br /> Address of -
<br /> 5. I am providing a booth wilh Ilse following (10 r?'atf ct 1 .:r ? 1, + 1 i 1<.nd-preparation areas frond flies,
<br /> dust and the Public)
<br /> J A booth with walls and ce,hng constnrcfed n'!-ir;`, ' i:la5:e,s,milar matarra':and fire mesh fly
<br /> screening, completely enclasigg open food arr::s ;t a srn,oclh And cleanable floor (concrete,
<br /> asohali. clean tarps and smooth woad are;<cr;:t..:,' ,, , ff 1:,separate food and food prcporation
<br /> ar,::,ir,f1on11he li:rblic.
<br /> Other(specify)
<br /> Note: The only operafions not reUuired to prMf�e 1:11cloSed 1300ths arc if os wr r'ch sell beverages from '
<br /> appravec dispensers,or prepackaged focdS,flo'n ii lfproved source-.--:
<br /> 6 Approved wale;for dr eking.utensil and hand washing wid be provided in my bcolh by ti,e fc%viing methcds:
<br /> JyA.pproved bottled water.
<br /> 0 On-site hose bib that is connected to a{)otabltr wAtr.r snurce
<br /> ❑Other(specify):
<br /> 7. Electricity is provided for my booth's use: Yes rL No
<br /> 8 1 am providing an accurate probe thermometer to measure tha hot and cold holding of potentially hazzardous
<br /> foods during all times of booth operation:M Yes(_]No
<br /> 9. 1 and providing the ful#owing hot lemperaluro Control for the hot holdi,19 of all potentially hazardous foods above
<br /> 135°F:
<br /> ❑Camp stove ❑Sterno&,ltgtel trays
<br /> Double steamer ❑Stearn table&lids
<br /> Electric stove top Other(specily) Ht,-, 1� yyl n
<br /> Note. Exarnptes:of potentially hazardous food include: ;;teats, tamales, cooked beans, rice, i
<br /> vegetables,potato Salad,eggs,and dairy products.
<br /> r
<br /> 1868 E,Hazehon Avenue I Stockton,CaAfornia 95206 1 T 209 469-3420 1 F 200 464-0138 t www.sjcelid.coni
<br /> etio;*ae Pops 7 or 11 rrre+'EVEwr APP
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<br /> https:#mail.google.comlmaillul0l#inbox/FMfcgzQbffVbHGcbgTszztHdCTvg W Gzl?projector-1&messagePartld=0.4 111
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