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4/26/23, 12:30 PM 20230426_120654.jpg <br /> -M <br /> S A N;,J0 A Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 /> 1. 1.Name of Event:; f'r''j .,;� j�'�,�/ /-- <br /> �. ..��_ �' ..a�Y`t�11r`�a�uate(s):,�dz�,..- - <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: C�o cr <br /> Andress ,(��Q/ rY.ri.� <br /> Phone: C 1 �'�'j 7/�2 ,p� Alternate:i.2ey�) �JJ u__2 <br /> 6CW'on ,rJre��r�nt+�,/,�cTy�t�a�f, A.-I e4 <br /> 3. List food to be sold or given to the public: /err�i�,/ r,I'dW lah-4&lc !S rr9. <br /> �c�Ct.t yu1J�%��CfziC,lctr� s�tr.✓�r s'��as - t'i1s <br /> 4. 1 am providing food that is NOT prepared at home: Yes X No <br /> All food is prepared on-site or is from approved commercial facilities:j(Yes❑No <br /> Name of facility: a,,,p6an'aff/�-�Ir�O/7 / Phone:(�G�&I 3'5/- <br /> Address of facility: /y�i �i" � ,eZ" 7TL,l1G'k <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> F� A 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 /> AOther(specify):262 2V�/' <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 /> 6. 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 that isconnected to a potable water source. <br /> Other(specify):Tl� '�sZ?/��✓ Sw�J <br /> 7, lElectricity is provided for my booth's user Yes❑No <br /> 8, 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operationAYes[-I No <br /> 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> []Double steamer ❑Steam table&lids <br /> ❑Electric stove top ,Other(specify) ;1��✓�r�t�:�/ <br /> Now: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue j Stockton,California 95205 1 T 209 468-3420 j F 209 464-0138 j www.sjgov Erg/eTidPP <br /> EHD 16.02 Page 7 of 11 <br /> TEMVhttps://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/QgrcJHrjCsBXLNTStWXBtSVngMCwFMIcGwb?projector=l&messagePartld=0.1 1/1 <br />