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Environmental Health Department <br />TEMPORARY FOOD VENDOR S APPLICATION <br />July 26lh & 27thDaie(s)1 Name of Event1 <br />2 <br />0^ <br />Address <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 />Note: Exompte* of potentially haiardou* food include: <br />vogateblM. potato aalad, agga. and dairy producta. <br />1868 E. Hazelton Avenue | <br />EHD »e-02 <br />06^02023 <br />7. <br />8 <br />Stockton California 95205 | T 209 468-3420 1 F 209 464-0138 | <br />PaQn 7 oT H <br />SAN JOAQUIN <br />- COUNTv <br />foods during all times of booth operation: [ <br />I am providing the following hot temperature <br />135’F: <br />O Camp stove <br /> Double steamer <br /> Electric stove top <br />All food vendors (both for profit and non-profit) are required to return a signed and completed "py >’,,1|S ' '>I|S' <br />the festival coordinator three (3) weeks prior to this event <br />Escalon Park Fete <br />www sjgov org/ehd <br />TfeMP EVENT APP <br /> Other (specify) ___*------==-------------- <br />Electncity is provided for my booth’s use [^.Yes U No <br />I am providing an accurate probe thermometer to measure <br />ER. Yes No <br />etontrol for the hot holding of all potentially hazardous foods above <br />The following is information about my organization/business <br />Name of organization/business <br />Le<L 14^/ . <br />Phone ( 7^ 1 >Alternate ( '/-IbI <br /> List food to be sold or given to the public UflSr_dED5 '' t <br />I am providing food that is NOT prepared at home ^ClYes I J No <br />All food is prepared on-site or is from approved commercial facilities Yes No <br />Name of facility Phone L_ 1 <br />Address of facility -------------------------------------—------------------------------------- <br />I am providing a booth with the following (Io protect my unpackaged food and food-preparation oreas from Hies <br />dusl and the public) <br />A booth with walls and ceiling constructed of either wood canvas plastic similar material c’ mesh fly <br />Gfeemnq completely enclosing open food areas II will also have a smooth and Jeanabl.- 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 /> 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 waler for drinking, utensil and hand washing will be provided in rny booth by the following methods <br />[^Approved bottled water <br /> On-site hose bib that is connected to a potable waler source <br />Q Sterno 4 hotel trays <br /> Steam table & lids <br />f^Other (specify) Y^ldt <br />meats, tamales, cooked beans, rice.