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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my boo’h by the foilowing methods:6. <br />Q Approved bottled water, <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />a. <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 cleanabje 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 />EfOther (specify): pi' ~r. d __ ____________________________ <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 />SAN JOAQUIN <br />- -COUNTY - - <br />I am providing food that is NOT prepared at home: Q Yes [BT'To <br />All food is prepared on-site or is from approved commercial facilities: Yes <br />Name of facility:Phone: f ) <br />Address of facilily:_ ________________________ <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 />'/ lj(<' <br />Phone: (Sy.1? i '7 s > • • 7 2- ______________ Alternate: f) ~7/ 7" V <br />List food to be sold or given to the public: r rZ-'c^. C, P<- 7' /?/'. 4 J/c <br />1868 E. Hazelton Avenue I Stockton, California 95205 ] T 209 468-3420) F 209464-0138 | www.sjcehd.com <br />EHO 16-02 -> Of H TEUP EVENT APP <br />C7z3Mr <br /> <br />Ail 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:pY c'7~ Date(s) >\( 24; 2024 > <br /> Sterno & hotel trays <br />0 Steam table & lids <br />0 Other (specify) <br />1 <br /> On-site hose bib that is connected to a potable water source. <br />Other (specify): by Q A $ Y-'?- y'.? <br />Electricity is provided for my booth's use: Yes 0 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: Fl Yes 0 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />0 Camp stove <br />0 Double steamer <br />0 Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: i'vx <br />Address: <-/g-' A