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Department <br />Envin <br />Of this checklist to <br />1. <br />2. <br />3. <br />4. <br />5. <br />fromwhich sell beverages <br />6. <br />9 <br />meats, tamales, cooked beans, rice, <br />/Tz? <br />7. <br />8 <br />SAN JO/ <br />COUN <br />o p Hazelton Avenue | Stockton. California 95205 | T 209 468-3-120 | F 209 464-0138 | www Sjgov.org/ehd <br />1^2 Pa98 7 '1 TEMP EVENT APR <br />or/oi/2025 <br />;ial facilities: <br />Phone: <br />flies <br />Name of organization/business: <br />Address: / i——-— <br />Phone: <br />List food to be sold or given to the public: <br />—— —jared at home. <br />^or is from approved commerd <br />enclosed booths are those <br />>roved sources. <br />■ided in my booth by the following methods: <br />TEMPOKASYrOOOVSNOOh^t.P.CA,^ <br />a signed and completed copy <br />All food vendors (both for profit and non profit) are ,G(ll‘l.r< Cf///ifa <br />the festival coordinator three (3) weeks prior Io this e / Date(s) <br />1. Name of Event: <br />The following is information about my organizal <br />I am providing food that is NOT prep. <br />All food is prepared on-^ <br />Name of facility: ___________ <br />Address of facility. <br />I am providing a booth fine mesh fly <br />dust and the public) canvas plastic, similar ma (concrete. <br />asphalt, clean tarps an <br />areas from the public. <br /> Other (specify): —------------- - <br />r^^o^ed bottled waler. <br />■. - - »— >— <br />1 lhe h0'holdin9 01 a" potentia"y hazardous foods above <br />' ai35PoF: Q sterno & hotel trays <br /> Camp stove & |jds , <br />D Double steamer ^^(specify) j <br />Q Electric stove top / <br />Fxamples of potentially hazardous food include: <br />N°te vegetables, potato salad, eggs, and dairy products. <br />No