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9ITJI22. 11:53 AM IMG-20220927-WA0001 .jpg <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to <br />Dale(S) __ _1.1. Name of Event: <br />2. <br />Phone <br />3. <br />4 <br />5. <br />are those which sell beverages from <br />6 <br />my booth by the following methods <br />9 <br />food include:meats.tamales, cooked beans, rice. <br />All food vendors (both for profit and non-profit) are required lo return a signed and completed copy of this checkts*. <br />the festival coordinator three (3) weeks prior to this event. <br />7. <br />8. <br />SAN JOAOUIN <br />COUNTY <br />The following is information about my organization business <br />Name of organizatiombusiness: £sA ^7 V\ .. <br />Address: .ASS’S tfr a.^, "iA-^ <br />-^-TOOL - <br /> y:- <br />[No <br />(o measure rhe hor and cold noldrng of potently hazardous <br />www sjgov org enj <br />ri:'.< ■ . •. . <br />_ Stockloh.ca1,1or„u195;^rj?;„4b8.<.;; F , ! <br />f A0&_fcfj'j - ____ Alternate’ ( <br />List food lo be sold or given to the public: <br />I am providing food that is NOT prepared at home Yes F] No <br />Ail food is prepared on-site or is from approved commercial facilities xZy es No <br />Name of facility: A.KPP fr>\< Phene (9 xO'>7 - 7 7 (7^ <br />Address of facihty .^SSS 9VF?M C. <br />I am providing a booth with the following Ito protect my unpackaged \x>d and food-preparation areas from flies <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wooc. canvas plastic, similar material ano fine mesh nv <br />screening completely endosmg open fooc areas. II will also have a smooth and cleanable floor (concrete <br />asphalt, clean tarps and smocth wood are acceptable) and constructed to separate food and fcoa preparation <br />ci’caS TfOn’ ifiG pUDlfC <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 feeds from approved sources 9 <br />Approved water for dnnkmg, utensil and hand washing will be provided -n <br />EfApproved bottled water. <br />[kftjn-site hose bib that is connected to a potable water source <br /> Other (specify)- <br />Electricity is provided for my booth s use Yes <br />I am prowling an accurate probe thermometer lo r;lcasUre me r <br />locos during all times of booth operation iv'Yes No <br />a^ng the W™.-.9 hoi temper eo^ for the hot hotd^ ot al. potent^ hazardOus to3ds Bbove <br />i..i Can p stove Sterno & notel trays <br /> Double steamer [vTsteam table & Ids <br /> Electric stove top Q other (specify) <br />Note; Examples of potentially hazardous f ; „IC1UI <br />vegetables, potato salad, eggs, and dairy products.