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Environmental Health Department <br />All food vendors (both for profit and non-profit) <br />Date(s); Saturdays 8:30 to 12:30 <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous8. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): _____ ______ <br />Note: The only operations not required to provide enclosed booths <br />List food to be sold or given to the public: <br />Name of organization/business: <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greatness here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: <br />The following is information about my organization/business: <br />pi <br /> Alternate: ( <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 three (3) weeks prior to this event. <br />River Islands Certified Farmers' Market <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 />I am providing food that is NOT prepared at home^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: j e^-^YPhone: <br />Address of facility: 1. > ''\Voaz-v Vm—> <br />I am providing a bootfiwith the following: (to protect my unpackaged food and food-preparation areas frdrh flies, <br />dust and the public) <br />SZ^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 I^ ^ona-ete <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparatio <br />areas from the public. <br />1868 E. Hazelton Avenue | Stockton. California 952051 T 209 468-3420 | F 209 464-0138 I vmw.sjceWc^^ <br />EHD 16-02 Page 7 of 11 <br />07/3/17 <br />O Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Brother (specify):_______ ___—--------- <br />Electricity is provided for my booth’s use: Yes L/pNo <br />I am providing an accurate probe thermorn^er to measure <br />foods during all times of booth operation: Q Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />IT] Camp stove EH Sterno & hotel trays <br />TT Double steamer O Steam table & lids <br />Q Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: