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3 ,r^-( ' <br />1 Name of Event: Paranormal Cirque Date(s): July 3 - 61. <br />2.The following is information about my organization/business: <br />Address <br />986-7502 687-6778Phone:Alternate: ( <br />3 <br />4 <br />5 <br /> Other (specify) <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />[~)t Approved bottled water. <br />S On-site hose bib that is connected to a potable water source <br />9 <br />meats, tamales, cooked beans, rice, <br />7 <br />8 <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 />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 />Name of organization/business. Cirque Entertainment III. LLC <br />2903 9th St West, Bradenton. FL 34205 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVEN r APP <br />07/01/2025 <br /> Sterno & hotel trays <br /> Steam table & lids <br />S Other (specify) Hot dog roller, cheese warmer <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth's use: KI Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 53 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 On-Site Phone: ( } <br />Address of facility: <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 />( 909 ) 986-7502 Alternate: ( 909) <br />List food to be sold or given to the public Popcorn. Cotton Candy. Hot Dogs. Nachos, SodasAV iter <br />% SANJOAQUIN Environmental Health Department <br />------COUNTY------- . <br />Greatness grows here. M <br />TEMPORARY FOOD VENDOR’S APPLICATION