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fl SAN JOAQUIN <br />COUNTY <br />Grer'' IF Oil' <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 />\'‘\ CCA/C- L5116(4/ <br />2. The following is information about my organization/business: <br />Name of organization/business: <br />Address: <br /> 3 0, coo Ke,-5- s 4,, Q./ <br />Phone: ( 1.01 ) 4 "1 - 1 1 <br /> <br />Alternate: (lo`‘ ) S' -7-5- <br /> <br />List food to be sold or given to the public: 1-4. co 5 <br />I am providing food that is NOT prepared at home: ai Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: N'Yes 0 No <br />Name of facility: <br />Address of facility: 500,0 KA-5 c , C 9,5-3 G y <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 />tg/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 <br />areas from the public. <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 foods from approved sources. <br />6. Approved waterfor drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />Q2Other (specify): V(i41\ <br />Electricity is provided for my booth's use: 0 Yes ti4 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: Ni Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Camp stove <br />Double steamer <br />Electric stove top <br />Stemo & hotel trays <br />Steam table & lids <br />Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <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 />1. 1. Name of Event: Date(s): <br />v-a_ C4, Phone:( )