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Docusign Envelope ID: A6F36A60-089C-4606-AB67-DB866ABAE8DC <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />5/17/2025 <br />1.I.Name of Event:Date(s): <br />2.The following is information about my organization/business: <br />Address: <br />510-363-7616Phone:()) <br />3.List food to be sold or given to the public: <br />4. <br />209-338-3663 <br />5. <br />Mri— Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Name of orqanization/busir&ssf Hits The streets <br />295 Bonner Dr <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 />0 Sterno & hotel trays <br /> Steam table & lids <br />0 Other (specify) <br />_____ Alternate: ( <br />hawaiian poke,acai <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness qrows here. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />music in the park <br />U Other (sp^cifyjrnpartment sink and hand wash sink <br />Electricity is provided for my booth’s use: Yes EJ 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: 0] Yes 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 Sterno & hotel trays serve cold food and Just a <br />— rice warmer <br /> Double steamer <br />0 Electric stove top <br />I am providing food that is NOT prepared at home: fl] Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: Maxs Kitchen LLC Phone: {). <br />Address of facility: 1211 s 7th street modesto ca 95351 <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 />0 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 />food truck