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Environmental Health Department <br />06/05 -09/4Farmers Markey1 Name of Evert:1. <br />2 <br />Addmse <br />( 209Phone <br />3.Let food to be soM or vven io tw puttie <br />4. <br />5. <br /> Otter (spedyX <br />Approved weter lor dnntong. ulensil and hand washing wdi be prowded m my boot) by the Inflowing methods:6 <br /> Approved bottod water <br /> Orvete hoee bto M « oonrwctod to a potatte weisr source <br />9 <br />Scanned with CamScanner <br />7. <br />8 <br /> Stomo A hotel trays <br /> Steam labia & bde <br /> Otwr (specify) <br /> A booth wflh wafls and ceflmg constructed of eflher wood, canvas, piasbe. similar material and fine mesh fly <br />screenmg. completely endosmg open food areas, n wdl also have a smooth and deanabie floor (concrete, <br />asphat. dean tarps and smooth wood are acceptabte) and constructed to separate food and food preparation <br />areas from the putAc <br />Note: The only operabons not requrwd to prowde endoeed bootw are those wtach sei beverages from <br />approved dBpensers. or prepackaged foods from approved sources. <br />186BE Hazelton Avenue | Stockton. Cataforrva 95205 | T 209 468-3420 | F 209 464-0138 | www sjcehd com <br />emo 'wj eae»7eii temv* event nee <br />onsir <br />SAN JOAQUIN <br />C OUNT V <br />” «• 11 Q ’ c-«»j • v <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Al food vendors (both for proflt and non-profit) are requred to return a signed and compteted copy of thro checktal Io <br />the fosbvai coordnator three (3) weeks poor to tse event <br />Note: Esaaiptee of potentaty hazardous food Include' <br />vogotabtee, potato sated, eggs, and dairy products. <br />_____ Atomate ( ) <br />Brazilian Pastel, coxinha <br /> Otter (speedyX M <br />Etectnoty a prowded for my booth's use. Yes K No <br />I am prtMdrtg an accurate probe ttermometer to meesure tte hot and coM hotong of poteneafly hazardous <br />foods dumg al frmes of booth operation EjYesQNo <br />I am provKfrng tte foflowmg hot temperature control lor tte hot hokfcng of afl poterteafly hazardous foods above <br />135T <br /> Camp stove <br /> Doubts steamer <br /> Electric stove tap <br />I am prowdng food that is NOT prepared at home. Yea g| No <br />Al food • prepared on-site or « from approved commerctal faeflifret: 8 Yes No <br />Sterne rrfteraty Tempero Goiano____________9^, (5iq 2379000__________ <br />Arirwwnffantor 12221 San Pablo ave Richmond <br />I am prowdmg a boot) wflh tte fottowmg (to protect my unpackaged food and food-preparation areas from flies, <br />dust and tie pufafle) <br />The loflowmg • mformaton about my organizabonfousmoss <br />Name of orgamzabonfousstess TemperO do Samba <br />835 Buckinghorse Drive <br />8556643