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t <br />Environmental Health Department <br />WATERMELON FEST - MANTECA I.Name of Event:Date(s):____ ____ <br />2. <br />3105 Morada Ct. Modesto CA 95350 Address. <br />Phone ( 209 )922-4475 <br />3. <br />4. <br />5. <br />from <br />6. <br />9. <br />meats, tamales. <br />'ice, <br />Z. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />fx] Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />required to return a signed and completed copy of this checklist to <br />Fl Other (specify)'___________ _________ <br />Note: The only operations not required to provide enclosed booths are those which soil beveraqo- <br />approved dispensers, or prepackaged foods from approved sources. ’ ‘ " <br />(xl 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 cleanablc floor (concn’to. <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />potentially hazardous food include: <br />,tato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Name of organization/business: Rhome’s Bistro <br />co°ked beans, <br />1866 e. Hazelton Avon.® I Stockton. California 952051 ,1^209 468-3420 | F <br />EHD 1602 <br />;)fV1l>'19 <br />sanjoaquin <br />-- -COUNTY----- <br />Greatness -grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />tooth's use: Yes No “ ’ -------------- <br />' " h°' o' Potentiate hazardous <br />I am providing the following hot temperature control tor Iho hot holding „f a|| potentially hazardous to a - <br /> camp stove Sterno & hotel trays <br /> (x| Steam table & lids Double steamer <br />., . . ( J Other (specify) Electric stove top <br />Note: Examples of <br />vegetables, poi <br />Alternate. ( )__ <br />PORK BELL Y CHIPS. PORK BELLY ADOBO. <br />l ist food to be sold or given to the publicr.HFFSFRI IRGFR-MI ISt IRI-PI77A I tIMPIAS I IRE & MELON DRINK <br />TURON, PUTO PAO <br />I am providing food that is NOT prepared at home: [Xl Yes No <br />All food is prepared on-site or is from approved commercial facilities: [xl Yes No <br />Name of facility: El Tac0 Qaxaco Phone. (510 ) 246-9012 <br />Address of facility 4717 Foothill Blvd Oakland Ca 94601 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation area:; from flics, <br />dust and the public)