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S A N.,41 Q A W N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> AN food vendors(both fix profit and non_rofi) are required to return a signed and compWad copy of this dtedcfist to <br /> the festi+rai coordinator three(3)weeks prior to this event.. <br /> 1- I.Name of Event k Date(s): 03 <br /> 2. The fallowMg is inbrrnatm about my organ¢aboNbusiness: <br /> Name of organizationlbusiness: <br /> Address: a '-1C) Y i <br /> Phone: 011E ) ;'--7S- 40 Altemate: (d--u �i a -_.0 4 <br /> 3. list food to be sold or given to the public: I'? <br /> A� F34rr,f v, e i m OL Qv k6&cL- (L.#,,f J r0-%� <br /> 4. l am providing food that is NOT prepared at home: [ Yes'' `No <br /> Alt food is prepared mode or n frorn approved cornrMcial facilities: 0 Yes❑No <br /> Name of fac&y.. Phone: <br /> Address of fadlfty: ___ <br /> 5. t am providing a booth wth the following: (to protect my unpack aged food and food-preparation areas from ties, <br /> dust and the pubW) <br /> P/J A booth with walls and ce*ig constructed of either wood, canvas, p}astic,siridar maternal and fine mesh Ily <br /> Wig. oorrrp+e" enclosing open tad areas_ tt wdl also have a Smooth and cleanable boor (wnarete, <br /> asphalt, dean t8rps and smooth wood are acceptable) and constnx#ed 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 those which $a beverages from <br /> aptaroved dispensers,or prepackaged foods from approved sow es. <br /> 6- Approved water for dri king, utensil and hand washing will be provided In my booth by the following methods: <br /> dAppnoved battled water. <br /> ❑CXI-Ske hose bib that is connected to a potable water source_ <br /> ❑Other(speay)_ <br /> 7. Electricity is provided for my booth's use-71 Yes U&o <br /> t3. I am providing an accurate probe thenriorr r to measure the hot and cold holding of potenfially hazardousods during aM tirrres of Mouth operation: Yes <br /> fo ❑No <br /> 9_ I am providng the iQiowing hat temperahrre control for the hot holding of all potentially hazardous foods above <br /> "F: <br /> .,/?JCam m a, <br /> p stove []Stea hotel trays <br /> L double steamer [Steam table&lids <br /> ❑EleQ stave top other(spedfy) C t,o�7&? c1rr kk <br /> NOW: E;xmnples Of poRenbadty turd xn food include_ meats, tarrfales, cootmd beans. rice. <br /> ve"bies,Potato salad,eggs~and dairy pwducts <br /> IBM E. Wazelton Avenue j Stockton, California 952051 T 209 468-3420 f F 209 464-0138 C www.sjgov.om/ehd <br /> ero+a-a« .�_..t_... <br />