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Environmental Health Department <br />1 <br />n -Mb 90V|I.Name of Event:1. <br />2. <br />eftAddress: <br />3. <br />4. <br />5. <br /> <br />6. <br />9. <br />meats, tamales, cooked beans, rice,Note: <br />7. <br />8. <br /> Other (specify):------------------------------------------------------------------ <br />Note: The only operations not required to provide enclosed booths <br />ruhrX a <br />SAN JOAQUIN <br />------COU NTY------ <br />(> / t'lil in's'- qrowi heir <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />foods during all times of booth operation:^ Yes No <br />I am | <br />135°F: <br /> Camp stove <br />“^3 Double steamer <br />'S3] Electric stove top <br />Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 85205 | T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 <br />07/3/17 <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 />Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />Other (specify): OXcar VAW VjAeV----------------------- <br />^TfSin^an^^ the hot and cold holding of potentially hazardous <br />Riding toe to^n^'to^urHoni^r toe hot hoiding of all potentially hazardous foods above <br /> Sterno & hotel trays <br />Steam table & lids <br /> Other (specify) <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 />CruhfX _ Date(s): <br />The following Is information about my organization/business: <br /> Name of organization/business: ——— <br /> <br />Phone: (U(A) 1^3 Alternate^ ) <br />List food to be sold or given to the pubncrVcRri\, <br />I am providing food that is NOT prepared at home?S Yes No <br />All food is prepared on-site or is from approved commercial facilities^ Yes No <br />Name of facility: K-VA —---------Phone: (-------L-----------------------------— <br />Address of facility: ______________________________________ ____—----------- ------------------- — <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fl , <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.