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K111!T,1 <br />SANJOAOUIN Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7- <br />8. <br />&. <br />Name of organizaGon/busmess: <br />Address. J <br />r.-^n<r <br />■ Jurrctf'‘‘ <br />5,' ------COUNTY------ <br />GreMmrts grc'vt bite, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />K<?amp stove <br />O Doublesteamer <br /> Electric stove top <br />Note: Examples Of potentially hazardous food include: <br />vegetables*potato salad, eggs, and dairy products. <br />EHo^iHa2ettOnAvenu6 l Stoddon, California 95205 | T 209 468-3420) F 209 464-0138 | wvw.sjgov.orc/ehd <br />“X’*n9 Pe#eT«11 TBVP EVEN1APP <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 threfip) weeks prior to this event. Webeptown farmers Market Sundays <br /> ,AxIC-^^is MAKK&f <br />The following is information about mwoioanizaiion/’liusiness.KiUG_______ <br />17^ PlA&d CfeFX <br />Alternate: ( ) <br />STtSAWleP KKfc, 4 CUtQ<eM APOCC7 <br />List food to bp sold or given to the public;cHiC4<gA! GKKLiC <br />I am providing food that is NOT prepared at home: foVes Ej No <br />AH food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facrtrty: Phone: ( ) <br />Address of facility. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. <br />dust and the public) <br /> A booth with watts 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 />pother (specify); ijSulG <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 foltowing methods <br />^Approved bottled water. <br />O OfFSie hose bib that is connected to a potable water source. <br /> oi, rx^teMAhi <br />' w^mi£XXX"b?«n“r,he “an<l,'°“n9 o' h^fc“ <br />1 ^5?£wdlnfl the h0' temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br />jzFSleam table & lids <br />Sather (specify) 3’ <br />meats, tamales, cooked beans, rice,