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Environmental Health Department <br />■r <br />I.Name of Event: 1. <br />2. <br />.e.Address: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />I <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------ <br />f' ;;'.r <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s)Aq <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 [ F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 TEMP EVENT APP <br />07/3/17 <br /> On-site hose bib that is connected to a potable water source. <br />[Q^her (specify): <br />Electricity is provided for my-6ooth’s use: Yes <br />I am providing an accurate probe thermometerjo measure the hot and cold holding of'potentially hazardous <br />foods during all times of booth operation: HYes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: <br />s pNnoey-o I—QC\V- \Vx3Sst VGJ>\ <br />Phone: (tSSQ A Alternate: (Co'SQ -Cf <br />List food to be sold or given to the public: n ------------ <br />I am providing food that is NOT prepared at home: 0Yes <br />All food is prepared on-site or is from approved comn <br />Name of facility: W" <br />Address of facility: <br />I ami <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0z6theT(specify): <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 />No <br />immercial facilities: B^/es No <br />Phone: <br />___ <br />providing a booth with the following: (to protect my unpackagedTo^d and food-preparation areas from flies, <br />Io