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0■f 17 2018 03:07 Postal Connections 2093560558 page 1 _ _ <br /> ■ ECEIVED <br /> ■■i r <br /> ■ ■ <br /> ■;■ MAY I ? 201 <br /> SANJOAQUIN EnvironmentdPllli r Ment <br /> COU N TY PWSFI2VIC <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Ali food vendors (both for profit and nort-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator thlfee(3)weeks prior to this event. <br /> 1_ 1.Name of Event <br /> Da#e s <br /> 2. The following is information about my organizationfbusiness: <br /> Name of organizatioNbusiness: A <br /> Address: P. U <br /> 4 <br /> Phone: <br /> Altemate: (2,0) , p <br /> 3. List food to be sold or givers to the pubilic: S S <br /> 1 t Ll <a <br /> 4. 1 am providing fobd that is NOT prepared at hom--X Yes ❑No <br /> Ali food is prepared on-siteor is from a <br /> pproved commercial fadlities:XYes ❑ No <br /> Name of facility: Phone: <br /> Address of Facility: <br /> 5. 1 am providing a tooth with the following: (to protect my unpackaged food and food <br /> dust and the public) preparation areas from flies, <br /> A booth with wails and ceiling constructed of either wood, canvas, plastic, similar material and fine mash fly <br /> cTeening, 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 constnicted to separate food and food preparation <br /> areas from the pubic. <br /> ❑Other (specify)-. <br /> Nota: The only operations not required to provide enclosed booths are those which self beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing wits be provided in my booth by the following methods: <br /> VApproved bottled water. <br /> ❑ 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: Yes❑ Na <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holdingof <br /> foods during all times of booth operation: Yes E:1 No <br /> potentially hazardous <br /> 9- 1 am providing the following hat temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F. <br /> ❑ Camp stove ❑ Sterno &hotel trays <br /> ❑ Double steamer ❑ Steam table& lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of Potantlally hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 � T 209 468-3420 1 F 209 464-0138 www.sjcehd.com <br /> EHD 1&Q2 Page 7 11 <br /> 07131,17 TEMP EVENT App <br /> - . ved Tlme M y, 17. 2018 3: 01PM Na, 3560 <br />