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? ^O^Mko-^23, <br />Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1 Date(s) Sundays 9am (o 1pm <br />2 The following is information about my organization/business <br />Golden R Inc <br />Address <br />Phone ( 209 ) 462-4738 Alternate. ( 209 ) 915-3772 <br />3 List food to be sold or given to the public biscotti and nuts <br />4 <br />5 <br />6 Approved waler for drinking, utensil and hand washing will be provided in my booth by the following methods <br /> Approved bottled water <br />9 <br />meats, tamales, cooked beans, rice, <br />7 <br />8 <br />Name of organization/business <br />12000 S Crocker Rd . Stockton CA 95206 <br /> 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 />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 /> Sterno & hotel trays <br />[J Steam table & lids <br />d Other (specify) no hazardous foods <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 />07/01/2025 <br />SAN JOAQUIN <br />COUNTY----- <br />G’rotnfb 9 ov.^ 1 <i( <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />I am providing food that is NOT prepared at home 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities Yes No <br />Name of facility Bimba’s Famiglia Phone: ( 209 ) 462-4738 <br />Address of facility:! 2342 Willow Glen Rd., Stockton, CA 95206 ____ <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />the festival coordinator three (3) weeks prior to this event <br />1 Name of Event Mountain House Certified Farmers' Market <br />foods during all times of booth operation [J Yes 0 No no hazardous foods <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />_135T <br /> Camp stove <br /> Double steamer <br />A Electric stove top <br /> On-site hose bib that is connected to a potable water source <br />Bother (specify) N;A not applicable <br />Electricity is provided for my booth's use H Yes 0 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />0 Other (specify) Table with banner