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Environmental Health Department <br />St. Bernards Parish Fall FestivalI.Name of Event:1. <br />The following is information about my organization/business:2. <br />Address: <br />607-7308209Alternate: () Phone: <br />Taccs & com cups List food to be sold or given to the public:3. <br />4. <br />835-4590 <br />5. <br />6. <br /> Approved bottled water. <br />the hot and cold holding of potentially hazardous <br />9. <br />vegetables, potato salad, eggs, and dairy products. <br />5 <br />Name of organization/business:st. Bernard's Pgiish Fall Festival <br />163 w. Eaton Ave. Tracy Ca 95376 <br />7. <br />8. <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths <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 /> On-site hose bib that is connected to a potable water source. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^ehd^ <br />EHD 16-02 Page 7 of 11 <br />07/01/2024 <br />( 209 <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 />Datefs): Sept 14th & 15th' 2024 <br />) 835-4560 <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: st. Bernard's church Phone: (209_l <br />Address of facility: 163 w- Eaton Ave~ Tracy Ca 95376______________________ <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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify): —------------ <br />Electricity is provided for my booth's use: L3 Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: 0 Yes 0 No u <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: „ <br /> Camp stove 0 Sterno & hotel trays <br />Q Double steamer 0 Steam table & lids <br /> Electric stove top Other (specify) Propane grin <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />SAN.JOAQUIN <br />li-'L. ' ----COUNTY----- <br />’ -- Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION