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Environmental Health Department SAN JOAQUIN TEMPORARY FOOD VENDOR’S APPLICATION I.Name of Event:1. 2. Address: Phone: 3. 4. 5. 6. 9. vegetables, potato salad, eggs, and dairy products. 7. 8. Name of organization/business: P.O. Box 1371 0 Other (specify): The only operations not required to provide enclosed booths Approved bottled water. On-site hose bib that is connected to a potable water source. [x] Other (specify): 3 compartment sink /1 hand washing sink / storage tank on truck-------------------------— the hot and cold holding of potentially hazardous Ripon, Ca. 95366_________________ _________________Alternate: ( 209 ) 539-2315 1868 E. Hazelton Avenue | Stockton. California 952051 1 209 468-3420 | F 209 464-0138 | «''™«^ThdApp EHD 16-02 Page 7 of 11 06/19/19 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: I am providing food that is NOT prepared at home: 0 Yes No All food is prepared on-site or is from approved commercial facilities: Yes No Namp nf facilitv Union Catering Truck Center Phone: (209 ) 298-5416 ------------------- ^on Street Stockton Ca. 95206 ______________________________ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and c'enable ’J°or asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food prepara areas from the public. Mobile Truck Electricity is provided for my booth’s use: Yes No I am providing an accurate probe thermometer to measure I amOproviding the\o^ hot holdin9 of al1 Potential|y hazardous foods above 135OF: Camp stove Sterno & hotel trays Double steamer Q Steam table & lids Electric stove top Other (specify) Nothing Hot Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, ( 209 ) 452-7108 List food to be sold or given to the public: Hot and Cold Coffee All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. /C/l V i 5 Q Date(s): / The following is information about my organization/business: Travel in Tom's of Lodi