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Environmental Health Department <br />G <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Dateijs): B/l 5/261. <br />2. <br />Phone:( 707) 6^4-6120 AJtemate: (:• <br />3.List "DOC tC SC Sold GF §veri tc the public: Llii>j:til mHU H-if ^ImI- tntx»>.Li:-u«4 funiiifafcOUi-ks l,u> E-.-mkI <br />4. <br />5. <br />| | Other (specify): <br />Apprwed water for drinking, utensil and "and 'washing wil be provided in my booth by the following methods:6. <br />0 Approved bottlec water. <br />| J On-site hose bib that is co""ected to a octaoe water source. <br />9. <br />7. <br />6. <br />L2 A booth with wals and cei ng constructed of either wcoc canvas, plastic, sinrar material and fine mesh fly <br />screening, completely enc'osing open food areas. It wB also have a smooth and cleanaoe fccr (concrete, <br />aschalt, c-ean tarps a"d smooth wood are acceptable) and constructec to separate food and food preparation <br />areas from the public. <br />Note: The cnly Dperalions not recuired to provide enclosed booths are those 'which sell beverages from <br />aoDrcved dispensers cr prepackages foods from approved sources. <br /> Other (specify): ____________________________________________________________________ <br />Electricity is provided fcr my booth's use: Yes I Nc <br />I am providing an accurate o-obe thermometer to measure the het and cold holding of potentially hazardous <br />Name cf organ zatiombusiiess: <br />Address: 135 Elena Ct Vallejo CA 945B9 <br />T"e following is information about my orga"izalion'business: <br />Ida s Eats and Treats <br /> Sterno & hate trays <br /> Steam table & lids <br />0 Other ispecfy| Hot Box Food Warmer and Spotlight <br />meats, tamales, cooked beans, rice. <br />I am providing food that s NOT prepared at home: 0 Yes Nc <br />All food is p’epared cn-ste or is from approved commercial fac ites: 0 Yes Nc <br />Name cffacBy: Morgens Kitchen Phone: ,707-^33-7961 <br />Address of faclih1: 1922 Broadway ValloiD CA 94690 <br />I am providing a cccth wth the fcllowng: (to protect my unpackaged feed and feed-preparation areas from, flies, <br />dust and the public) <br />1B6BE Haze ton Avenue I Stockton, California 95205 I T 209 468-34201 F 209 464-0138 www-sjgav.orgi'eid <br />fcHJ lb-O! ''■aaraltl TEWI’bVEN I APP <br />GT/aiiiiaai <br />SAN JOAQUIN <br />-COUNTY— <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all tmes of booth operation: 0 Yes No <br />I am providing the following hot temperatire control fo- the hot holding of a potentially hazanfous foods above <br />135eF: <br />El Camo stove <br /> Double steamer <br /> Electric stove top <br />All food vendors (both fo- profit and non-prafrt) are required to return a signed and competed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: 541tl Annual Bal™ r(C5ta