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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />county <br />Date(s): <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 />O' Approved bottled water. <br />E^On-site hose bib that is connected to a potable water source. <br /> Other (specify): _________________ _______ <br />Electricity is provided for my booth’s use: (V^Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: G Yes No <br />1 a" PJ?vidin9 016 followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br />EZI Camp stove Q Stemo & hotel trays <br />G'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 />Jun Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06/19/19 2 Pa96 7 °f 11 TEMP EVENT APR <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: 4?^ /A/ / d <br />Address: JLi 2- ! j<V\ <br />^10}—5^7 5 7^ 5 Alternate: (^/o <br />List food to be sold or given to the public:c^z7^^/ o fl id <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: Q^es No <br />Name of facility: (TT Phone: g/fj '0(^0Q <br />Address of facility:/X 7^ I .r <br />I am providing a booth with the following: (to protect myunpackaged food and food-preparation areas from flies <br />dust and the public) <br />JEfA 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 />aXsfrom^he pubLand Sm0°th W00d are accePtab,e) and constructed to separate food and food preparation <br /> Other (specify): ______________________