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Date(s) <br />1. <br />2 <br />c(f <br />Address <br />) <br />Phone <br />3 <br />4 <br />5 <br />io -rtuCK <br />6 <br />9 <br />meats, tamales, cooked beans, nee. <br />7. <br />8 <br />Alternate ( <br />ite <br />1 Name of Evert <br />The followng ts •nfonmatton about my organuation/busincss <br />LOMA IO <br />piZ <br />foods dwnnQ all times of booth operation Yes ©'No <br />l am i <br />135T <br />R Camp stove <br /> DouMe steamer <br />Pl Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, Cakfornia 95205 | T 209 468-34201 F 209 464-0138 | vww.sjgov org/ehd <br />EHD 'M2 ” TE*** EVENT APR <br />Name of organizatioM)us>ness <br />loos'] fgig-uenwL <br />List food to be sold or given to the public <br />Approved water for drWung, utensrf and nano washmg w.11 be provded m my booth by the fodowmg methods <br />[j Approved bottled water. <br />O On-sde hose txb that ts connected to a potable water source <br />f/omeriswoM lUStOT TD0O TTUiOv ____________________________ ____ <br />eiectncdy « pravioeo for my boom s use □vesi'3'Tlo <br />l am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />« is i — <br />providing thc"foltowmg hot temperature control for the hot holding of aH potentially hazardous foods above <br /> Stemo 4 hotel trays <br />[~~1 Steam table 4 lids <br />GX>ther (specify) 1 <br />Environmental Health Departm©' SAN JOAOUIN <br />‘ ------COUNTY------- <br />< * Greatness here, <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and comp <br />the festival coordinator three (3) weeks poor to this event <br />SHOW <br />Al! food • prepared ar« Hom --------- <br />NameoffaoMy ___________________________ ____J— <br />Address of facility , 'rj I F --—J------. ..n^i food'and food-preparation areas from flies. <br />I am providing a booth with the following (to protect my unpackagc <br />dust and th® public) <br /> A bcm .u« ana ««> <br />2£ XZU anb’eon,^ .o sapa^e -cod and loob p«pa— <br />areas from the puWc <br />Other (specify)