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Environmental Health Department <br />1.1 .Name of Event: Qur Lady of Guadalupe Festivities Date(s): Dec. 1 1-12,202 1 <br />The following is information about my organization/business:2. <br />Name of organization/business:Our Lady of Guadalupe Parish <br />Address: 16200 Cambridge Dr. Lathrop,95330GA. <br />Phone:Alternate: () (209 )858-4466 <br />3.List food to be sold or given to the public: Tamales <br />4. <br />5. <br /> Other (specify): <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />S Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />7. <br />8. <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 /> Sterno & hotel trays <br /> Steam table & lids <br />E Other (specify) Grill <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APR <br />06/19/19 <br />H 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 />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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth’s use: S Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0 Camp stove <br /> Double steamer <br />0 Electric stove top <br />SANJOAQUIN <br />” tiller J -------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: n/A_______________________________Phone: ( ) <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />meats, tamales, cooked beans, rice,