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03 <br />Environmental Health Department <br />2 <br />Phone <br />3 <br />4 <br />5 <br />6. <br />9. <br />meats, tamales, cooked beans, nee, <br />■ f hazardous <br />iotato salad, eggs, ant - <br />8. <br />SAN JOAQUIN <br />COUN T V <br />1 Name of Event Clements Stampede <br />The following is information <br />Name of <br />B]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 the public. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator ^ree^’^eks'p^^5^ requ'red return n signed and completed copy of this checklist to <br />1 <br />F 209 464-0138 I <br />that _____________________ <br />w”dedfojrarny^ ,he hot and c01d h0|ding of potentially hazardous <br />hot holding of a" po,en,ia"y hazardous foot,s above <br /> Sterno & hotel trays <br />^Steam table & lids <br /> Other (specify) <br />3 food include, <br />id dairy products. <br />Alternate ( )________ <br />public: <br />lam providing food that is NOJ prepared at home: Q No AI I OH Sl/e. <br />II food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: -------------------- -------------------Phone. ( ) <br />Address of facility:______ <br />' a^sTand^the pu>bl?c)1 ^°"OW*nQ: Pro^ect my unpackaged food and food-preparation areas from flies. <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 /> Approved bottled water. <br /> On-site hose bib that is connected to a potable wate,-source. L . <br /> Other (specify): <br />Electri , . <br />I am providing an <br />foods during all times <br />I am providing the f—- <br />135°F; <br />0 Camp stove <br />^Double steamer <br /> Electric stove top <br />Note: Examples of potentially <br />vegetables, p*— <br />about my organization/business <br />orgamzabon/busine^^b^Gn^k <br />Address lEJkZJfexIfl I <br />List food to be sold or given to the <br />■--^r 1868 E Hazelton Avenue | <br /> Date(s) 10/18-19/2025 <br />Stockton. California 952051 1^209 468-34201