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, WUJUAQU f I enVironalentai rieairn ueparira ens <br /> �`0:r,�' ' �2et�r�ss g=ttrvs �ief�. <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 checklist to <br /> the festival coordinator three (3)weeks prior to this event. <br /> 7. 1.Name of Event: �' rL Date{s): <br /> 2. The following is information about ganization/business: <br /> r <br /> my r <br /> Name of organization/business s <br /> Address: <br /> ! <br /> 3. Gist food to be sold or given to the public: fl r <br /> 4. 1 am providing food that is NOT prepared at home: EKes❑ No <br /> XI food is preparedsite or is from approved commercial facilities: lalx(es❑ No <br /> ge <br /> Name of facility: ,I ) Phone: 7 -~ L 3 VK <br /> ,address of facility: <br /> Z i am provrdrng a onul wnri ine wtiowing: tto plote(z-fly unpacxageo t000 an o u roa-preparation areas from rries, <br /> dust d the public) <br /> booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> s reening, 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 /> ❑ Other(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 /> 6. ;Approved <br /> ra d water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> bottled water. <br /> ❑ On-site nose bsb that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use:JZYes 0 No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot <br /> d cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes❑ No N <br /> 9. 1 am providing the following hot temperature control for the hot hol all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑5terno& hotel trays <br /> 1-1 f�ru.ihlp.�fe��nrar. r I;�feam ta}-ilc�R.,lids. <br /> ❑ F�ectric'st4vae+-top [l[7.ttrer(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products, <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I wvvw.sjceho.com <br /> EHO 16-02 Page 7 of 11 TEMP EVENT APP <br /> o 713117 <br /> r <br />