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.y <br /> PM IMG 20240213 031547 956.webp(10t. 320) <br /> SAN 1OAOUIN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All loud vendors{both lot profit and ncn-profit}are required ro return a signed and completed copy of this checkSst to <br /> the festival coordinator Ihrea(3)weeks onor to this event <br /> 1 1 Name of Evert. RWB Pest Datets): March 232024 <br /> 2 The following is informalron about my araanpzaiicn//N siness, <br /> Name of organizaiicnlbusirless. Fruitopla Fruit Bowls <br /> Address 821 kilarney court lathrop ca 95330 <br /> Phone. f ) 209 969 7292 A�.ternate t <br /> 3. List food to be Sold Of giver to the public Fruit bowls and fruit products <br /> 4 1 am providing boll Thal is NOT prepared at tome. Yes❑No <br /> All food:s prepared on•sde ur is fmrn"proved commercial facilities:leyes 0 No <br /> Name of facility phana.f <br /> Address of lacihl f <br /> 5 t am providlrg a woth with the following.Ito protect my unpackaged food and food-preparation areas tram 14es, <br /> dust and The public) <br /> ❑A booth with walls and ceiling constructed of either wood.canvas,plastic,similar matenai and fine mash fly <br /> screening, completely enctos,ng opor food areas It will also have a smooth and clearabin floor{concrete. <br /> asphatl.clear,tarps and smooth wocd are acceprable)and constructed to sepwale food and food preparation <br /> areas from the pub,lc <br /> 10tt.er(specify) -- Food trailer <br /> Note: The only operations nol required Io provide enttosed booltis are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources <br /> 6 Approved water for drinking.utensil and hand washing will be provided in my tooth by the following melfrl <br /> �spproved bolded wafer <br /> ❑On-site hose bib that is connected to a potable water source <br /> Other Ispecdy <br /> 7 Ekctncny is proviaed lot my booth s vse 'Yes"No <br /> a I am provdirg ar accurate prctta thermometer to measure the hot and CCId holding Of ppll hazardous <br /> loads during all rmes of Imam operatan ayes❑No <br /> 9_ 1 air psp•nding the following hol temperature Corti l for Ihs hnI nolding of all polerlrally F'azardaus foods above <br /> 135`F <br /> []Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Eleciric stove top N/A n0 hot foods <br /> Nate: Examples of potenliaNy hazardous food include: meats, tamales, cooked beans. fte, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 c Sl L uplc,n•ra 4620,1,. T 209 4t}•5-'i-Uu F G.-., :,,-r Gl3H avow sNG'l arty-al'd <br /> d,; "W EVEMT AAP <br /> 9tretMi� <br /> rile:[//C:IUserslhburkhart/ApoData/Local/Microsoft/WindowsllNetCache!Content-Ouilooklt69PSH16IIMG 20240213 031547 955.webo 111 <br />