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Environmental Health Department <br />Phene: <br />3. <br />4. <br />5. <br />6. <br />9. <br />moats, tamales, cooked beans, rice, <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />TEMP EVENT APPPage 7 of 11EHO1S-02 <br />1. <br />2. <br />7. <br />8. <br />U Pry noAvch <br />(s.m)JX^oo------------------- <br />List food to be sold or given to the public: <br />I am providing food that is HQI prepared at home: Yes SI No <br />All food is prepared on-site oris from approved commercialfacilities: Yes KI No <br />Name of facility: \ Phone: [-------)----------------------------------- <br />Address of faciHty: _______. ---------------------------------------------------------------------—:-----------------—----- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparatton areas from flies, <br />dust end the public) feoWi <br /> A booth with walls and celling 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 /> Other (specify): ---------------------------------------------------------—--------- <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br />□ Other (specify):>V^\V ---------------- --------------- -----------------------------------— <br />Electricity!is provided for my booth’s use: U Yes 18 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: Yes0 No <br />I am providing the following hot temporature control for the hot holding of all potentially hazardous foods above <br />135*F: 1 <br /> Camp stove Sterno & hotel trays <br />Q Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Noto: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />i <br />SANJOAOUfN <br />-l-COUNTY" <br />G| ‘.-lit '>‘ .'.5 Ijioiv-, hvll'. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) aro 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: ^DlT^A^EST-lVAl.-------------------- <br />The following Is information about my organizatlon/business: <br />Name of orgamzation/busmess: ■ > >—.uumzu-i—/ <br />AHrl Of "2- 3 5 («• 'V) C. Pl X" A-ta \ C_______________________________________ _ <br />Ad d res s: ■— -------——• ■ J <br />Alternate: ( -S' ) 30 1 " -------------— <br />Date(s): SEP 11-14.2025