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Environmental Health Department <br />i Date's) 1 <br />2. <br />Aacress <br />Phone <br />3 <br />4 <br />5 <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6 <br />9 <br />meats, tamales, cooked beans, rice. <br />7 <br />8 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />------COUNTY------- <br />Great-nesi growl here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />^"Approved bottled water <br />On-site hose bib that is connected to a potable water source <br />0Other (specify) TIA-RjL C tfYVx pfA f iw I' _________________________________ <br />Electricity is provided for my booth's use. ptYes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation £2 Yes No <br />I am providing the following hot temperalure 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 />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 />1868 E Hazelton Avenue I Stockton. California 95206 I T 209 488-34201 F 209 464-0138 | wwwsjgov.org/ehd <br />EHO IB-02 7 Of 11 6veN' *PP <br />07'01/2024 <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 £>I.1(K Pnrhi (\h <br />The following is information about my orgamzation/business <br />Name of orgamzalion/business Sp-HV <br />Ckvisr/uc p.^Af-1 Twu <br />(W _ Alternate <br />CA _______ <br />(l(/l > _______ <br />List food to be sold or given to the public UlVlp , Pvlb/A bjiV- , L\Y\<a 11 ((A , ^([61^, P~)tZ\h V I <br />fjrfftY'S ’ T J <br />I am providing food that is NOT prepared at home: H Yes No <br />All food is prepared on-site or is from approved commercial facilities Yes No <br />Name of facility. V ft 'Pi*) Phone (2^)) ~ H -i <br />Address of facility: 2)-^ S (1 h. y |'s I'V'XGt P r\ T~ra(.ll CA c I P»'1)'T~^/___________ <br />I am providing a booth with the following (to protect my unpackaged food aVid food-preparation areas from flies <br />dust and the public) <br />2j..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