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f-opy of this checklist to <br />Datefduly 24th and July 25th, 20262. <br />Address: <br />Phone: <br />) 3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />__Ia)A v-i <br />the hot and cold holding of potentially hazardous <br />I am providing the following hot te’mperatur^iontrolfor the hot holding of all potentially hazardous foods above <br />I □□ I . <br />O Camp stove Q Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) f\t>A C <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />-Qonvi I < <br />°n Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I wwwsjcehdcom <br />f’^070'11 ' • TEF^P EVENT APP <br /> <br />SAN JOAQUIN <br />-COUNTY <br />(’I ii (//nv.s <br />TEMPORARY food VENDOR’S APPLICATION <br />the festival coordinator three"!) weeksp'li^’fo this eve^l’t0 *' | 8 and ^Wfeted < <br />1- 1. Name of Event. <br />Environmental Health Department <br />07/3/17 <br />Note: The only operations not required to provide enclosed booths are those which sell hpv0,=n0t r <br />approved dispensers, or prepackaged foods from approved sources. beverages from <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 water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br /> <br />The following is infonnallon about my organiz£,iion/business <br />Name of organizalion/lxisiness: <br /> —BJaZIKL^) i n e. <br /> <br />_______Alternate; ( <br />List food to be sold or given to the public: Wl JQ4~ <br />I am providing food that is NOT prepared at home: l^Yes No <br />Name ofSfaPcZtPared 00 8,16 fl°m apPf0Ved commercial facilities^Yes □ No <br /> <br /> Address of facility: ~ Phone. £-------)------------ ----------------------- <br /> dust and the pu^ W*th ’b" f0“0Win9’{to Prolectmy unpackaged food and food-preparation areas from flies, <br />sheening, completely encbs'ng open^ood lreasthIt wS^ls^have a'sm^th™1 n)ateriai and fine mesh <br />a^aslmTeX^ ~^-Ta^ <br /> Other (specify):_______