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TEMPORARY FOOD VENDOR’S APPLICATION <br />2^7 <br />SAN JOAQUIN IblJNTY <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />BmineM! ^420 <br />I <br />i <br />Phone: ^L b y 7 ~ Alternate: 7 <br />3. List food to be sold or given to the public: <br />4. lam providing food that is NOT prepared at home: [»(] Yes <br />All food is prepared on-site or is from approved commercial facilities: M <br />Name of facility: 52WO Pho <br />Address of facility: S <br />5. lam providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />p>? A booth with walls and ceiling constructed 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 constructed to separate food and food <br />preparation areas from the public. <br />[ ] Other (specify):__________ ___ <br />Note: <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />checklist to the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: 727/^^ <br />2. The following is information about my organization/business: s <br />Name of organization/business: <br />Address: <br />Phone: <br />> [ ]No <br />‘ ’ Yes [ ] No <br />Phone: <br />Date(s): <br />1^:1. I <br />■ Jh IM.1 <br />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 />M Approved bottled water. <br />M 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: f/j Yes [ ] No <br />8. lam providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all time of booth operation: [^Yes [ ] No <br />9. I 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 />[ ] Stemo & hotel trays [ ] Steam table & lids [ ] Other (specify): <br />Note: Examples of potentially hazardous food include, meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />’ ..