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EnvoronmentaB Heafth Department <br />1. <br />Date(s): OCT 4-5, 2025 <br />2. <br />Address: <br />Phone:() <br />3.List food to be sold or given to the public: <br />4. <br />650-745-5010 <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />________ Alternate: ( <br />prepackaged dry dips <br />SAN JOAQUIN <br />COUN • v <br />The following is information about my organization/business: <br />Name of organization/business: • Sunrioo Kiwams — <br />ED On-site hose bib that is connected to a potable water source. <br />0 Other (specify):N/A <br />Electricity is provided for my booth's use: Yes 0 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: ® Yes No <br />' .vidin9 the fo,lowin9 hot temperature control for the hot holding of all potentially hazardous foods above <br />CZI Camp stove Q sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) a. v <br />the festival coordinator three (3) weeks prior to this <br />1. Name of Event: <br />800)592-7419 <br />Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.siqov.orq/ehd <br />tHU 16-02 panB7nfll ------------a_. - <br />are event"66 t0 retUm 3 Si9ned and comP|eted C0Py of this checklist to <br />Manteca Pumpkin Fair <br />Note: The only operations not required to provide enclosed booths are those which sell beveraoes from <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 />El Approved bottled water. <br />I am providing food that is NOT prepared at home: S Yes No <br />All food is prepared on-site or is from approved commercial facilities: K] Yes No <br />Name of facility: Yummy Dips Phone- ( ) <br />Address of facility:—215 Live Oak Cir, Roseville CA 95678 <br />' ^sTandthe puWfcO f°ll0Win9: (t° prOteCt my unPackaged food and food-preparation areas from flies. <br />Ereeni^nthrnmnS|S and |Ce'-in9 const!:uct®d of either wood- canvas, plastic, similar material and fine mesh fly <br />asohal n? y T Op€”lf00d areaS' wil1 a,so have 3 smooth and cleanable floor (concrete <br />areas from^the public d W0°d a"* acceptable) and constructed to separate food and food preparation <br />S Other (specify)- protective floor and professional canopy, wall will be used for samples preperation