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fRc&itfZ.S* <br />Environmental Health Department <br />?Oato(«): Saturdays 830 lo 12-30 <br />2 <br />! <br />Pisone: <br />3. <br />^(209)324-6477 <br />5. <br />6. <br />9 <br />meats, tamaies, cooked beans, rice. <br />Environmental Health Department <br />11. <br />OR <br />12. <br />containw with spigot). <br />13. <br />••Importanr* <br />7. <br />8. <br />F 209464-0138 j www.sjcehd.cofn <br />rtMP evfcwr w <br />I <br />! <br /> . <br />H signed and completed copy of this dwextet to <br />SAN JOAQUIN <br />------COUNTY------- <br />Gr<nfn««j erorfs htrt. <br />' l«T«>erawe control tor 8® cold hokStg of polentas, haaa-dats foods bet™, <br />45 F -if food is used the following day. matniarn below 41T temperature): <br />13 *ce chests Q RefngerHtof <br /> Refrigerated truck O Jce bath and tubs <br /> Other (speerfy) <br /> Water supply dspenser win warm water at a minimum of 10O'F (i.«. 5-20 gallon <br />8 Ono separata tub (bucket or baste) for ths collection of nnserwastewatur <br />® Paper towels and pump-style soap container. <br />1«6^_ Hazenon Avenue) Stockton. California 352051 T 20S 465-34201 <br />otont n^.r«« <br /> ,emS W*h'n ™ bO°8’t,W San'a'y ^"teg of food preparation utensa <br />a bieatdt <br /> Detergent bleach, and wiping ctolhs (dearang towels). <br /> Tub io Store wiping ctoths in Weach solution <br />l^am prawdfog thu foaowing ia attenuate hand washing faai,t®a. but separate from utensa wash within my <br />to. <br />1 of 2 .AN JOAQUIN <br />- — COUNTY-- <br />Cr«&tncif. ftere <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />M food vendors (both lor profl: and nonprofit) are requited to return <br />«»fastwd coordinator three (3) weeks prior to this event. <br />1. Name of Event: Rtvor islands Certified Farmers' Market <br />The foSowing is information about my organization/busine'.s. <br />Name of orgartzatjorVbustness Dunya Foods I AC. <br />Andress: 931 Tannehill Dr. 95337 <br />< )-925 393-3042 79253526322 " ~ <br />List food to be sold or given to the pubfic. Picklsd VGQtablGS , ScdScl , TOG <br />I am providing food that« HPT prepared a. home. ® Yes □ No Concentrate <br />zr^r^io^sWymis 577 n° <br />Addn&ss of tacsty:2005 east ave turkock ca *” <br />1 foliO“n9' unpadreged food and‘fi«hprepatal«n areas hSZS^ <br />S^S’’!^X,J^,and^Oitnfl consi?aoa aa,e'WDOd- <=>"*•’ stmUur matonal and «na mesh fly <br />saeenmg. romptetefy enefostng opon foot areas. Il wdl also have a smooth and deanable tar (concrete <br />XtoXSte” W0W) 9<x8plabte’ *™» «*>«rectM to separate food and food preparation <br />O Other ispeafy):___________________________________ <br />ND,*r ®p“ro6on= required to provide endosed booths are thoso which se« bcrerages tom <br />approved dispensers, gt prepackaged foods from approved sources <br />Approved water for linking, uleraH and hand wasfwg w» he provided in my booth by the foUowtng methods: <br />S Approved bottled waler <br />G On-site hose bib that is connected to a potaUe water source. <br /> Other (specify): Eiedridty is provtocdfnr my boolh's use: Yes No --- ----------------------------------------------------- <br />1 prcbe ^^rrwter to measure toe hot and cold holding of potentatfy hazsrdous <br />foods dunng all times of booth operation:® Yes O No —z^aous <br />I am pra-weing the following hot temperature control for the hoi holding of an potenbally hazantous foods above <br />Q Camp stove fl stemo A hotel trays <br /> Doulste steamer Steam labte Stats <br /> eocbs stove lop Q Other (specify) <br />Note: Example, of potanlially hazardou. food mcluifo <br />vegetables, potato salad, eggs, and dairy product*.