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Environmental Health Department <br />Sundays Apr-Apri. <br />2. <br />Address: <br />PbOHK <br />crA/d broteJ3.. <br />4. <br />5. <br />M/i4-LiS <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />H Approved bottlad water <br />9. <br />Note: Examples jot potentially hazardous food include:meats, tamales, -cooked beans, rice, <br />7. <br />8. <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 />O Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />ZJresD No <br />Phone: <br />The following is information about my organization/business: <br />Name of organization/business: rf£AJ^ <br />r?ro <br /> 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 pubi»c <br />List food to be sold or given to the public: V iiAAvuvnur, c <br />. Aon Z' ■< o o <br />____ Afemater ( T ~ <br />M SAN JOAQUIN <br />------cOUNTY— <br />^reaifiess groi*i <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 fesfiv^ crxxdinaiQr ihrae (3) weeksprtarto this avtefr. <br />1 Name ofEvent: Webers town Farmers Market <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 ) www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br />I am providing food that is NOT prepared at home: Yes QT^o <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of tadfity: rv~iiA--S ________Phone: (^3~S~1 Cp <br />Address of faaTity. [T T ■ <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />Q On-site hose bfo that is connected to a potable water source. <br />□ Other (specify/^_ _ _ _ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods-duririg all times of booth operation: Yes Q No <br />f am providing toe tofiowtng hot temperature control for the hot hofcfing of aS poterttaSy hsadous foods above <br />f35T: <br />EJ Camp stove <br /> Double steamer <br /> Electric stove top