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I <br />Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />nat^Sundays Apr-Apr1. <br />t <br />2. <br />Address: <br />AKcsnaterCPbom <br />c h.".3.. <br />4. <br />5. <br />f~F Other ispeafyfr <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />O Approved poifiad water. <br />9. <br />Mote: Examples jof potentially hazardous food include:meats, tamales, oooked 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 />ISS’F: <br />EJ Camp stove <br /> Double steamer <br /> Electric stove top <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 me petotic <br />T—_________ <br />1888E. Hazelton Avenue) Stockton, California952051 T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page? oT 11 TEMP EVENT APP <br />07/3/17 <br /> <br />thefas&^N coordinator 8tf»(3)weeksprtxtodfls went <br />1. Name of Event. Weberstown Farmers Market <br />SANJOAQUIN <br />--COUNTY- <br />Grectfsess ^rows ..f>ere,. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />O On-site hose bib teat is connected to a potebte water source. <br /> Other (specify <br />Electricity is provided for my booth’s use: Yes O No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />faodsduring Ml times of booth operation: Q Yes Q No <br />I am providing the tottwvmg hot temperature control for the hot hoidfog of at potertcaty ftsadocs foods above <br /> Stemo & txjtei trays <br /> Steam table & lids <br /> Other (specify) <br />List food to be sold or given to the public: V <br />T>—>l <br />(CX6 ) ct Q - M 4, 3 1 <br />The following is information about my organization/business: <br />Name of organization/business: ftUMrvtu-< <br />ITD fy-, | f Z ft C\g^~° <br />I am providing food that is NOT prepared at hornet Yes STio <br />All food is prepared on-site or is from approved commercial facilities: QTYes No <br />Namebffedtty: r>-v ia-S H~Cc<v-£»-x Phone. (^ys~) {'Cp ~ <br />Address of fadBy- D L.«yrr>lrQ -...... < <br />I amproiadirtg a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public)