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Address: c/ The following Is infonnation about my organization/business: Name of organization/business: 1:02 AM Scan 20230328 jpg SAN JOAQUIN Environmental Health Department 01J NT v TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) rim required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 1.Name of Event: ______SICli,,'11M-1:--;)J-TZ) }iJf•JC:L-- a-, Phone: (70 ) 46- 77 C List food to be sold or given to the public: Z/C. 4Ir• Address of facility: f--;./S" r „ --e-& / C: X .57 , 5. I am providing a boofhKvith the following: (to pr t my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. S. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: L-Zroved bottled water. ZOo-site hose bib that is connected to a potable water source. Li Other (specify): 7. Electricity is provided for my booth's use: Yes Li No a. I am providing an accurate probe thermomi, to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 1.E. Yes 0 No 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135`F: 05.,:_amp stove 0 Sterno & hotel trays Double steamer Steam table & lids 0 Electric stove Lop Ej Other (specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. 1868 E. Hazelton Avenue I Stockton, Collfornin 95205 T 209 466-3420 I F 209 464-0138 I www.sjgov.orgiehd ENO 1G-02 Popo 7 of 11 TEMP EVENT APP 'Zi19/1L ffe.com/mail/u/0/llinbox/FMfcgzGxRnVilvmNBxVdTzttgfpwJBbaprojector=1&messagePartld=0.1 I am providing food that is NOT prepared at home: JYes 0 No All food is prepared on- •r is fr2i n a pror.,d commercia acilities: Name of facility: Yes 0 No .,Phone: Date(s): z.z)2.4/ 1321 CamScanner