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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />1 <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Other (specify):___________ ________________ <br />Note: The only operations not required to provide enclosed booths <br />x .... <br />'es No <br />Phone: (___ <br />n/ousmess: , <br />• .Ca <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EUD16-.02 Page 7 of 11 TEMP EVENT APP <br />0773/17 <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br /> On-site hose bib that is connected to a potable water source. <br />y/other(specitviZii^b/'YirA W -C \ <br />Electricity is provided for my booth’s use: Yes □No' - <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ^xes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />% SAN JOAQUIN <br />' —county---- <br />Greothess grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />' ) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. \ . —TjClOrk fe.sn 1 s <br />r*S>h ac. k <br />(2-^ A -C~. Alternate: ( 26A------ <br />L^ttoodtobeso.dorg.vento^puMickr ■ CWcVcp V ' <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: O ~ eJc £ . \ jU-iT~(A I CA <br /> <br />fam proving Xoth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material anc' m^h fly <br />Keening, completely enclosing open food areas. It will also have a smooth a"d <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />All food vendors (both for profit and non-profit) <br />1. Name of Event: HA arrterri. - I i her <br />The following is information about my organization/business: <br />Name of organization/business: L-LO— ---------- — <br />ah^s: J w HT.1Q , manto <br /> Alternate: ( ------