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Environmental) Health Department <br />Date(s): October 4th and Sth <br />2. <br />Address: <br />Phone:592-7419 ) <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />___________Alternate: ( <br />Pumpkin Bread <br />( 800) <br />List food to be sold or given to the public: <br />SAN JOAQUIN <br />COUNTY <br />1. Name of Event Manteca SUnrise Kiwanis Pumpkin Fair <br />The following is information about my organization/business: <br />Name of organization/business: Manteca Sunrise Kiwanis <br />PO Box 752 Manteca, CA 95336 <br />are those which sell beverages from <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />Hazelton /Xvenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sigov.org/ehd <br />0?/?!^ Page 7 of 11 TEMP EVENT APP <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 />CJ Approved bottled water. <br />C] 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: | | Yes I | No <br />1 Providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />I oO i 1 <br />O Camp stove Q Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Noto.* Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: E Yes No <br />All food is prepared on-site or is from approved commercial facilities: E Yes No <br />Name of facility: MUSD BeTech Culinary School 209 . 825-3200 <br />— i 11U11 “. [ )_________ <br />Address of facility: 2271 W Louise Ave Manteca, CA <br />1 JfTndih9 3 W'th the fo,,owin9: (t0 Protect my unpackaged food and food-preparation areas from flies, <br />uusi ana me puoiic) <br />S^b00th Wlth yv?ll.s and .cei,in9 constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />9; co™p|ete,y enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />areas fromVhe pubhcand Sm°Oth W0°d are accePtab,e) and constructed to separate food and food preparation <br /> Other (specify): N/A