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SAN JOAQUIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />10/18-19/2025Date(s)1. <br />2 <br />Address <br />Phone <br />3. <br />4 <br />5 <br /> Other (specify): <br />those which sell beverages from <br />6 <br /> On-site hose bib that is connected to a potable water source <br />9 <br />■ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />pfApproved bottled water <br />7 <br />8 <br />01 <br />Environmental Health Department <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources <br />All food vendors (both for profit and non-profrt) 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: Clements Stampede <br />k 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 />^TTSterno & hotel trays <br /> Steam table & lids <br />^J2<Jlher (specify) (eI(jrrvll <br />m c i * 'Ta.bl^ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />"fable, fail <br />meats, tamales, cooked beans, rice, <br /> Other (specify) <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometerjo measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation^Qyes No <br />1 a™ por°vldin9 the followir>9 hot temperature control for the hot holding of all potentially hazardous foods above <br />Pfcamp stove <br /> Double steamer <br /> Electric stove top <br />The following is information about my organization/busmess: <br />Name of organization/business. <br />2,30 Mzx/b______ <br />( IO Alternate: ( ) <br />List food to be sold or given to the public: f bLVvtg rice f Hoc, n Qrae-sg. <br />3ves No <br />Phone: () <br />1868 E Hazelton Avenue j Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www siqo>' ^>m^nd <br />om'mi Paoerotn TEMPEveirwP <br />I am providing food that is NOT prepared at home: Yes PTNo <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: <br />Address of facility: <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)