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Environmental Health Department <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />559-840-1948 <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />7. <br />8. <br />SAN JOAQUIN <br />“COUNTY------ <br />The following is information about my organization/business: <br />Name of organization/business: PINO Boba <br />4654 E Donner Ave, Fresno, CA 93726 <br />559-270-3585 <br />Date(s): 10/04-05/2025 <br />are required to return a signed and completed copy of this checklist to <br />Note: The only operations not required to provide enclosed booths are <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 />[^Approved bottled water. <br />d On-site hose bib that is connected to a potable water source. <br /> Other (specify):_____________________________________ <br />Electricity is provided for my booth’s use: Q^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 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Stemo & hotel trays <br /> Double steamer £/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 />( ) Alternate: ( ) 559-281-3384 <br />List food to be sold or given to the public: Boba Drinks, Kettle Corn, Fried Rice, Chow Mein, Egg Roll <br />BBQ Chicken & Teriyaki Chicken <br />I am providing food that is NOT prepared at home: Q^Yes No <br />All food is prepared on-site or is from approved commercial facilities: O' Yes No <br />Name of facility: 15 Tea _____ Phone- f____) <br />Address of facility: 132 W Nees Ave Ste. 103, Fresno, CA 93711 <br />* ^st'and th9 3 fo,,0Win9: ^to protect my unPackaged food and food-preparation areas from flies, <br />£Za booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify): <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />07/01/M24 Pa98 7 0111 TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are ivMU;„ ‘ <br />the festival coordinator three (3) weeks prior to this event <br />1. I.Name of Event Manteca Sunrise Kiwanis Pumpkin Fair