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Environmental Health Department 1. Name of Event: Address: Phone: List food to be sold or given to the public: 3. 4. 5. 222^4 6. pproved bottled water. On-site hose bib that is connected to a potable water source. AUG 1 4 2024 9. meats, tamales, cooked beans, rice, Page 7 of 11 7. 8. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 of 11 __ TEMP EVENT APP 06/29/2023 Sterno & hotel trays Steam table & lids Other (specify) Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: PAYMENT RECEIVED SAN JOAQUIN -----COUNTY-----F Greotness grows herb. TEMPORARY FOOD VENDOR’S APPLICATION Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. n 2. Name of organization/business: / i ( S Alternate: ' • I am providing food that is NOT prepared at home: [jj Yes No All food is prepared on-site or is from approved commercial facilities:,^ Yes No Name of facility: u' c' Phone: (Q-^) - ^^2 5 £ Address of facility: D I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) □A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify): CL- A / Note: The only operations hb^ required to provide enclosed booths are thss^JA/hich sell beverages from approved dispensers, or prepackaged foods from approved sources. Other (specify): /■__________________________________________________________ Electricity is provided for my booth’s use: [VYes No SAc n§m Ka lNTY I am providing an accurate probe thermometer to measure the hot and cold fi^i^d-t^terltiallyjhazardous foods during all times of booth operation: N3 Yes No I am providing the following hot temperaturebontrol for the hot holding of all potentially hazardous foods above x235°F:H-Camp stove Double steamer Electric stove top All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Oy /I f: /,fr'ATL, The following is information about my organization/business: /) r, /A J __________ l\ Xv/ aJli J