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I ir 'I; <br />Environmental Health Department <br />i. <br />2. <br />Address. <br />Phone.' <br />3, <br />4. <br />5. <br />6. <br />9. <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />T 209 468-3420 | F 209 464-0130 | www.sjgov.ora/ehd <br />-•’1 TEVP EWNI APP <br />SANJOAQUIN <br />-----COUNTY------ <br />Grcpt.'i<!55 grc-vJ h^re. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />l /. 7 7// 7. n /_ ' <br />thd Hazelton Avenue | Stockton, California 95205 |------ <br />CXV’91'9 Paf4?«f11 <br />1'5’ <br />7 .• ( L-■ <br />• |VTr 1 <br />All food vendors (both for prom and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator threeH) weeks prior to this event. Webeptowp F/rniers Market Sundays <br /> 1 Name of Event Date(s)7V.X(-/WXkX <br />The folkwing is information about rmuoroanijalion/liusiness: <br />Name of organizalion/busmess: <br />\J&L PIA6LC2 CkferX £-ro<’XTrxl,04-cl5XX <br />List food to be sold or given to the publionll I ftfeO cKetMEK, GftfvU C CUl CK€M. t NlO . <br />I am providing food that is NOT prepared at home: tef/es No . 1 <br />AN food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of fadlrty: 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 />O 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. <br />ifafe kW.ilGK.WWMS AW fefrliOS ■StateI X€cM£. <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 />O On-site hose bib that is connected to a potable water source. <br />O^ther (specify): <5 IklUjkiW $ <br />Electricity is provided for my booth's use Yes Qrio / ---------— 1 x_>, <br />' 'he ho'an<l ““hoMi'’9 0' po'en'la", ha!a,d’“s <br />’ a^£c.Vld,n9 the fol,owil19 hot temperature control for the hot holding of all potentially hazardous foods above <br />©Camp stove Q Stemo & hotel trays <br /> Double steamer fB’Sleam table & lids <br /> Electric stove top JJDther (specify) (2/|3oC^ <br />N°‘e: venSt 0L,P?,ent,iaLly hazardous food include: meats, tamales, cooked beans, rice,