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SANIJOAQUIN <br />—COUNTY -- <br />.• - <br />rEg LOgenki, <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <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 />1.Name of Event: DogShow <br />The following is information about my organization/busines.s: <br />Name of organization/business: ccoffac <br />Date(s): 11-143°24 <br />Address: 1,10 West Kellternan Una Lull CA95240 <br />Phone: ( 925 ) 470-9576 Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 2 Yes 0 No <br />Name of facility: Carol Carle* Phone: ( <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) <br />EI 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 areas from the public. <br />0 Other (specify): c000. <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 />CI Approved bottled water. <br />3 On-site hose bib that is connected to a potable water source. <br />El Other (specify): <br />Electricity is provided for my booth's use: 0 Yes LI 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: El Yes LI No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />1355F: <br />El Camp stove LI Sterno & hotel trays <br />0 Double steamer 0 Steam table & lids <br />El Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1888 E. Fiazelton Avenue I Stockton, California 95205 I 209 468-3420 F 209 464-0138 J www.sjgov.org/encl EHD 16 -02 Page 7 of 11 TEMP EVENT APP 06/29/2023 <br />Address of facility: 1110 West Kellerman Uwe , Lodi CA 95240