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SANdOAOUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Dalefs/ <br />2 <br />-«oaiess <br />Phone <br />3 <br />4 <br />5 <br />6 <br />q <br />i vegetables, potato salad, eggs, and dairy products. <br />7 <br />a <br />I <br />!■- <br />Mo11 Avenue | Slocklon California 95205 T 209 468-3^120 F 209 r.Jb <br />Ptfjr ’ c> 11 <br /> A txxitti wnh walls and ceiling constructed of either wood, canvas, plastic, similar material and line mesh fl, <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />asphan clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />OthRr (specify) ______________ <br />Note The only operations not required to provide enclosed booths are those which sell beverages from <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 /> On site hose bib ihat is connected io a potable water soutce <br />JX Other (speatyj ____ <br />Llectncity is provided for rny tioolti s uuj Yes | | No <br />I am providing an accurate probe thermorncler lo measure the hot anil cold holding ol potentially hazardous <br />foods during all times of booth operation jX/es I. I No <br />l am providing the following hot temperature control lor the hot holding of all potentially hazardous foods above <br />i J Camp stove Q Sterno fi hotel trays <br />'[ ^Rouble steamer Steam table & lids <br />l J Electric stove top jXO,hor (specify) V/i?/'/?’f" <br />^ot|(|.- Examples of potentially hazardous food include: meats, tamales, cooked beans, nee, <br />AU loo<i vendors (both toi profit and non-profit) ate required in reiurn a signed and rximpleted copy of this checklist tn <br />the festival comlmatof throe (3) weeks prior lo this event <br />‘ - z / , / / ' <br />i NameoiEven . Manteca Park-A-Paldoza August 5, 2023 <br />The lollowmo is information about my orqanizaliorvbusmess: <br />Name of otoamzatrorVbus.ness ^3^ .../Yl?zO <br />... Alternate <br />USI kxw 10 tx. SOW o, evon «, pub,lc. <br />e/i'CtSr, <br />I am prodding kxxj that is NOT prepared at home f l Yes No <br />■\U food is prepared on site or is from approved commercial facilities: {XYes No <br />Name of faohtv Phone fa 3</- JMQ <br />Adaress of laaiitv . jp/Z/zx/^y< ~'777r'/w lr______ <br />I am providing a booth with the following: (to protect my unpackagod food and food-preparation areas from flies ’ <br />dust ano the public)