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Environmental Health Department <br />i.Datei's): Fnday. May 24th <br />2 <br />Address; <br />Phone ( <br />3. <br />4, <br />9167127540 <br />5. <br />6 <br />9. <br />meats, tamales,vcooked beans, rice. <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------ <br />grein hetn <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Q On-stte hose bib that is connected to a potable water source <br />E2 Other (specify); Water tanks on the mobile food facility <br />Electricity is provided for my booth's use: 0 Yes Zj No ' " ' ' <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentaJiy hazardous <br />foods during all times of booth operation 2 Yes O No <br />I am providing the fallowing hot temperature control for the hot holding of ail potentially hazardous foods above <br />135’^ <br />I—I Camp stove r~l Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top 0 Other (specify) Smoker <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />are required to return a Signed and completed copy of this checklist toAtt food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: Kai&er Stockton Lunch <br />Alternate: ( ) <br />List food to be soio or given to the public Tn Tip, Pulled Pork and Potato Salad <br />’^8 E Fiazeiton Avenuel Stockton California 95205 | T 209 468-34201 F 209 464-0138 I www stcehd com <br />Note: The only operations not required to provide enclosed booths are tnose which sell beverages from <br />approved dispensers or prepackaged foods from approved sources <br />Approved water for drinking utensil and hand washing will be provided in my booth by the following methods <br />O Approved bottled water <br />I am providing food that is NOT prepared at home Yes sZ No <br />Ail food is prepared on-site or is from approved commercial facilities. Yes [J No <br />Name of facility Smokine Ewe BBQ & Catering Phone < <br />Address of facffrty. 225 G Street, Davis. CA 95616 <br />l am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />_i A booth with walls and ceiling constructed of either wood canvas plastic similar matenal and fine mesh fly <br />screening completely enclosing open food areas. It will also have a smooth and deanabie floor (concrete, <br />areas fronTtoe13'^ Srn°Oth WOO<I arG 5Cce^taWe^ ana constructed to separate food and food preparation <br />0 Other (specify) Mobile Food Facility <br />The following is information about my organization/busioess <br />Name of organtzation/business: -bmokin Ewe BBQ <br />765 Stratford Ave, Dixon, CA 95620 <br />I 916-712-7540