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1 <br />Date(s): <br />4,. <br />3, <br />4. <br />6. <br />Page 5 of 6 <br />v. <br />7 SAN <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />Business: (209) 468-3420 <br />7. <br />8. I am <br />^rJOAQUTN COUNTS <br />checklist to the festival coordinator three (3) weeks prior to this <br />1. Name of Event: <br />2. The following is information about my organization/business, <br />Name of organization/business: <br />Address: <br />Phone: ^t9 -f* <br />fl <br />TY <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br />methods: <br />Approved bottled water. <br />[v] On-site hose bib that is connected to a potable water source. <br />[kf Other (specify): <br />Electricity is provided for my booth’s use: [v^Yes [ ] No <br />providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all time of booth operation:-----[vpfes [ ] 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 />[ vfCamp Stove [ ] Double steamer [ ] Elecfric stove top <br />[Stemo & hotel trays [ ] Steam table & lids [ vfOther (specify): <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />; event.. <br />out my organization/business: <br />, Q^l t <br />^3’— *3 ‘Alternate: 3-0 *7* t <br />List food to be sold or given to the public: JgJg^ L <br />I am providing food that is NOT prepared at home: [tzfYes [ XT- <br />All food is prepared on-site or is from approved commercial facilities: [v^Yi <br />Name of facility: x ■' <br />Address of facility: <br />5. lam providing a booth with <br />flieSj, dust and the public) <br />[ ]No <br />'es [ ] No <br />L—___________ Phone: 7=0^ <br />e following: (to protect my unpackaged food and food-preparation areas from <br />[ZA 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 />[ZOther (specify): <br />Note: