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SAN JOAQUIN <br />COUNTY <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: is 0 C. <br />The following is information about my organization/business: <br />VI t t Fr- Ca'CATC- Loo J <br />Address: 12.5- S. 5 <br /> <br />Phone: (2...0 ) I 0-0(e/3 Alternate: ( <br />List food to be sold or given to the public: 14boti- VCOAS tr/5 / COP 101 CC WA-"TXX2-' <br />I am providing food that is NOT prepared at home: Yes E No <br />All food is prepared on-site or is from approved commercial facilitiestØ Yes 0 No <br />Name of facility: at./1114Slig4 s 5 -r $ osv hone: (1,i ITV -Pb 1 3 <br />Address of facility: 11.,c t4 I 0 4-04t tx S 5 7- <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 />OA 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 />NE),Other (specify): 66a ¶9-Al ix 5 <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 />lApproved bottled water. <br />lyiOn-site hose bib that is connected to a potable water source. <br />E Other (specify): W` tvt. v Ai gt, ty. <br />Electricity is provided for my booth's use: EI Yes El No <br />I am providing an accurate probe thermometer to measure the hot and <br />foods during all times of booth operation: El Yes IA No <br />I am providing the following hot temperature control for the hot holding of <br />135°F: <br />[11 Camp stove El Sterno & hotel trays <br />El Double steamer <br />D Electric stove top <br />LI Steam table & lids <br />n Other (specify) 5 i5 a. to, -Faso u 1— <br />Note: Examples of potentially hazardous food include: meats, tamales, <br />vegetables, potato salad, eggs, and dairy products. <br />cooked beans, rice, <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />Date(s): <br />Name of organization/business: <br />vi/SOAP <br />cold holding of potentially hazardous <br />all potentially hazardous foods above