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Environmental Health Department <br />Date(s): Saturdays 8:30 to 12:30River Islands Certified Farmers' Market1. <br />2. <br />Address: <br />) Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />I <br />t <br />7. <br />8. <br />J3 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greotness here. <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 festival coordinator three (3) weeks prior to this event. <br /> Other (specify):----------------------------------------- --------------------------------------------------------------------------------------- <br />Electricity is provided for my booth’s use: Yes 0 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />’ . •• r '/i xx__I "T a.i_ <br />VIUI II IS4 C4II Ml I IX**# XXI IXVWM « wVI W.■ •- y , • —. r <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br />H Other (specify) A)/ A <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 18-02 Pass 7 of 11 TEMP EVENT APR <br />07/3/17 <br /> <br /> Other (specify):——— <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.Name of Event <br />The following is information about my organization/business: <br />Name of organization/business: O/'/ s /• oncV.—/^c-/W <br /> yill //(tywafcL <br />___________Alternate: ( <br />/4/// <br />I am providing food that is NOT prepared at home: [EfYes □ No <br />All food is prepared on-site or is from approved commercial facilities: El Yes No <br />Name of facility: fig u ---------------Phone. (JHq ) —O---------------- <br /> Address of facility: I jo 3 Xf, -----i-rcsnw Z—4^.-------— -------------------------———— <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 />0 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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Electricity is provided for my booth’s use: Yes 0 No <br />foods during al) times of booth operation: 0 Yes 0 No <br />I am | <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: