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SAN JUAQUIN Environmental Health Department <br /> —C aU r4TY— <br /> Greatness grows here, <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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. ,r:i <br /> 1. 1.Name of Event: V1 -ed ��k� Date(-): P2 `} <br /> 2. The following is Information about my organizationlbusiness: <br /> Name of organ izationlbusiness: 0ec -e-4- and Toi4 ,- �e <br /> Address: IDI o CaI/`e ' 41Sn Crt atj&.1 CA <br /> Phone: ( Z09) 2 $g Altemate:( ) <br /> 3. List food to be sold or given to the public: Sin i> L'a 1 � <br /> 4. 1 am providing food that is NOT prepared at home:�Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities:YYes❑No <br /> Name of facillty: Phone:( �_ <br /> Address of facitity: s, <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑ 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. II <br /> other(specify): Fps Trn;1&�_ -- <br /> Note: The only operations not required to provide enclosed booths are those which se0 leverages from <br /> approved dispensers,or prepackaged foods[Tom approved sources. <br /> 6. Approved water for drinking,utensil and hand wasmny will be provided in my booth by the fotlow'ny methudy <br /> ❑Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potabla water source. <br /> (specify): <br /> �Othar <br /> 7- ctricity is provided for my booth's use:❑Yes❑No of potentially hazardous <br /> 8, 1 am providing an accurate prahe,themiom <br /> ..: . <br /> er to measure the hqt ash c. d, to $ <br /> foods during all times of booth operation: es❑No h=rdous foods above <br /> g. 1 am providing the following hot temperature control for the hot hokling,iva <br /> 135"F: hotel tray} <br /> El Camp stove ❑Sternu 8 yg1. <br /> ❑ Double steamer ❑ Steam table$lids - <br /> ❑ Electric stove top Other (specify) <br /> wolfed beans, rice. <br /> Mote: Examples of potentJaliy hazardous toad bndude,- r ,�r, <br /> vegetables, Potato salad,eggs, and dairy products <br /> ems' r r <br /> 61 'aEgrNhA <br /> 1868 E. liazelion Avenue { SSockton, California 95205.1 T 208468-342 <br /> 7ol11 <br /> EHO <br /> 09 M2023 - <br />