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Environmental Health Department <br />/' 2- <br />Phone <br />3. <br />4. <br />5. <br />6. <br />9. <br />food include:meats, tamales, cooked beans, rice, <br />I <br />I <br />1868 E. <br />EHD 1602 <br />7. <br />8. <br />www.sjgov.org/ohd <br />TEMP EVENT APP <br />5^/ h'i <br />I <br />SAN JOAQUIN <br />COUN' \ <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All few vewor, (both fo, pron, and non <br />the festival coordinator three (3) wweks prior to II <br />1. <br />List food to be sold or given to the public <br />I am providing food that is NOT prepared at home M Yes No <br />AH fooo is prepared on-site or is from approved commercial facilities Wyos No <br />Name of facility: ' W/V'PhonB;(^) " 7/f/ <br />Address of facility <br /> dusl and the puMte)1 010 followln0: (t0 pr0,ect "V “npackagad food and food-prepartXion areas from flfes^ <br />s^nT^c^olntaltlnel^ conslr(uc'ed o' either wood, canvas, plastic, simitar material and ftne mesh fly <br />asphalt clean taros and ,mMih °Pe^ f°Od areas u,11 Wl11 a,so have a smooth and cleanable floor (concrete, <br />areas• fromTeX aCCePtab'e) C°nStrUC,ed t0 Separate food and food Preparation <br />^other (s^’: Ac/W Ay /h / Co/t 4 <br />dTXn:.xzx.tod Kim-sx: -those whfch - <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methode: <br />O Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):________________ <br />Electricity is provided for my booths use: □ Yes Vj'no --------------------------------------- <br />,he h°' a"d “W of PdtentlaHy hazardous <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sferno & hote| <br /> Double steamer Q steam table & |jds <br /> Electric stove top Q other (specify) <br />Noto- Examplos of potentially hazardous <br />vegetables, potato salad, eggs, and dairy products. <br />Hazelton Avenue , Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 I <br />07/01/2051 Pago 7 of 11 ' 1 <br />^,Vl't}^r° roq“‘','d 10 ri'h,rn a slgrifHl and complnfod ropy <>f (hut < hockhsl lo <br />• Name of Event <br />nate(s) <br />The following is Information about my organization/buslness. <br />Nameoforyanizatiombusiness <br />Address -PlO>£*_212_ Manto, <br /> Alternate ( ) <br />l^Yes No