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SAN JOAQUIN COUNTY <br /> f ! '<I ENVIORMENTAI, HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,California 95205 <br /> ` Business: (209)468-3420 <br /> ` 1 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> vendors(both for profit and non-profit) are required to return a signed and completed copy of this <br /> ;,kh,,t to the festival coordinator three (3)weeks prior to this event. l <br /> Name of Evcnt: -AU/ Dates S <br /> The following is information about my <br /> o ani ati-on;b_business. <br /> Name oforganization/business: r <br /> .- ---...Address L -- <br /> -_ <br /> Phone 0 9- �b5-6 LQ_ Alternate: <br /> I.rst food o be sold or given to the public: _ i <br /> Vfr, <br /> 4 1 am providing food that is NOT prepared at home: Yes ( J No <br /> All food is prepareZ___e7�e <br /> ite o r� m approved c9mmercial facilities: Do Yes [ ] No <br /> Name of facility: 5�ie Xc i 0-5 Phone: <br /> Address of facility-. .Y � _ 6 mac' veid" _ Cat ,�'S3L 7 _ <br /> 5 1 am providing a booth with the lowing:(to protect my unpackaged food and food-preparation areas from <br /> flies,dust and the public) <br /> N1 A booth with walls and ceiling constricted of either wood,canvas,plastic, similar material and fine <br /> mesh fly screening,completely enclosing open food areas. It will also have a smooth and cleanable floor <br /> (concrete, asphalt,clean tarps and smooth wood are acceptable)and constricted to separate food and food <br /> preparation areas from the public <br /> [ ]Other (specify)- <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 /> 6 Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br /> methods. <br /> [ Approved bottled water. <br /> [ On-site hose bib that is connected to a potable water source. <br /> [ ] Other(specify): <br /> 7. Electricity is provided for my booth's use: Do Yes [ ]No <br /> 8 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all time of booth operation: a] Yes [ ]No <br /> 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br /> above 135 degrees Fahrenheit: <br /> [ ]Camp Stove Double steamer [ ] Electric stove top <br /> QQ Stenno &hotel trays [ ]Steam table &fids [ ] Other(specify): <br /> I <br />