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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />SAN JOAQUIN <br />•COUNTY-— <br />meats, tamales, cooked beans, rice. <br />are those which sell beverages from <br />a signed and completed copy of this checklist to <br />----------- --------------- Date(s): Q-( <br />™?j2HaZelt°nAvenUe| S'00'''®'’, California 952051 T 209468-34201 F 209464-0138 | ww.sjgov.org/ehd <br />07/01/2024 PafleTofll TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />and are required to return <br />he festival coordinator three (3) weeks prior to this event. <br />1. Name of Event HOUmAlH <2/^ <br />The following is information about my organization/buslness: <br />Name of organization/buslness: PCfeSl'Q <br />Address: 2^ Avtyi.clg -Tne, ^12-3 <br />Phone: ___________ Alternate: (gig) <br />List food to be sold or given to the pubfc:TI^P?76? I /ft * <br />I am providing food that is HQT prepared at home: No <br />All food Is prepared on-ste or Is from approved commercial facHWes: HVes No <br />Name of facility: C&V* Phone: M ~ 731 -SN <br />Adtfress <br />foeX? ** 9; (t° P ^d^-preparetion'are^s from ffies. <br />XfcXXT1 SmO°,h aC“P'al>,e) and '» separate food and food pieparation <br /> Other (specify): ____________ ___ _______________ <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 ba provided In my booth by the following methods: <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Bother (specify): Qppr'Pv£.c) CO <br />7. Electricity is provided for my booth's use; Yes H^No ’ -----------------------------------*---------------- <br />a ' hot and ““htWn9 * hi™ <br />I am proving the foflowmg hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays <br /> Double steamer Q] Steam table & lids <br /> Electee stove top SDther (specify) g>uvV\er <br />Note: Examples of potentially hazardous food include: 1 <br />vegetables, potato salad, eggs, and dairy products.