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SAN.!dOAQUIN <br />„A •CAIDUNTY— <br />REC-008 <br />Environmental Health Department <br />Phone: 206-863-3873 Alternate: 925-339-4469 <br />3, List food to be sold or given to the public: Italian Ice <br />Phone: 209-608-5455 <br />/1. I am providing food that Is NOT prepared at home. es \le <br />All food is prepared on-she or Is from approved commercial facilities: <br />Name of facility: Stockton Community Kitchen <br />Address of facility:110 N El Dorado St, Stockton, CA <br />,amp stove <br />ouble steamer <br />leotric stove top <br />Sterno, & hotel trays <br />Steam table & lids <br />Other (specify) <br />Date(,: <br />6-15-24 <br />7-4-24 <br />7-20-24 <br />DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />t*:•10"wi0 * Gr 0 ss grows here, <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />M food vendors (both for profit and non-prolit) are required to return a signed and completed copy ol this checklist to <br />the festival coordinator three (3) weeks nor to this event. <br />Music in th neteenth Fourth of July <br />2, The following Is Information about my organization/business: <br />Name of organization/business: Heavenly ice <br />Address: 17562 Capricorn Ct, Lathrop, CA 95330 <br />5, I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from Illes, <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar mated at and fine mesh fly <br />sor ening, 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 />nOther (specify): <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 />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />nApproved bottled water, <br />n-site hose bib that is conneoted to a potable water source. <br />I—F;I:tricity Is provided for my booth's use <br />Pier (specify): <br /> <br />8. I am providing an accurate probe the <br />foods during all times of booth operation <br /> <br />9, I am providing the following hot lemperatu <br />Ye illo <br />.r IPasure the hot and cold holding of potentially hazardous <br />Yes \lc) <br />ontroi to the hot holding of all potentially hazardous foods above <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products, <br />1868 E. Hazelion Avenue I Stockton, California 95205 I T 209 468-3120 I F 209 481-0138 I www.sjgov.orgiehcl <br />Eue 16.02 Page 7 of IS ILIAP EVENT APP <br />06/19/19 <br />1. 1,Name of Event: MIP July <br />STI c...0