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Environmental Health Department <br />.Li FesT/1. <br />2. <br />Phone: <br />3. <br />4. <br />1 <br />5. <br />and cleanable floor (concrete, <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Q On-site hose bib that is connected to a potable water source. <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: IJJy es Q No <br />1 Pr°viding the Allowing hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F: <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />E Hazeton ZWenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />oX7°2 Pagezofll tempevent app <br />1. Name of Event: Wl^aWrn I <br />The following is information about my organizatlon/business: <br />Wameofo^anlzationfbuslness:. RxH t A Bo \ F< IFST <br />Address: v\|V/ H-CMO , mdcVen Cr< <br /> —Zo*"! -C~,‘ I ---------- Alternate: ( ^1/.Q ZS I <br />List food to be sold or given to the public: tSifo FT~ <br />I am providing food that is NOT prepared at home: &Yes No S <br />All food is prepared on-site or is from approved commercial facilities: ^Cs □ No <br />Name of facility: 6 . UV tTB He Rhone- ( <br />Address of facility: <br />dust and the public^ fo,,owin9 (to Protect my unpackaged food and food-preparation areas from flies, <br />areas from the public. acceptable) and constructed to separate food and food preparation <br /> Other (specify): ________________ <br />Note: Innrnt?^dPeratiOnS nOt reqUired t0 provide enclosed booths are ^ose 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 /> Approved bottled water. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />*re,um a si9ned and ddmpte,ed o< this cbMkfe, ,0