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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: Date(s): <br />2. <br />Address: <br />Phone:()) <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY— <br />required to return a signed and completed copy of this checklist to <br />pfiS^ £ /4? <br />i'rp CA^aw] <br />Note: The only operations not required to provide enclosed booths are <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 />0 Approved bottled water. <br />Oc-I- <br />LU On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: 3-Yes 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: 0 Yes No <br />1 Vid'n^y®/followin9 hot temPerature control for the hot holding of all potentially hazardous foods above <br />LU Camp stove LU Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />1 ti1?1 <br />I am providing food that is NOT prepared at home: 0 Yes LU No <br />All food is prepared orvsite or is from approved commercial facilities: 0- Yes No <br />Name of facility: V t P, l>o /-5_____________Phone: Y/J? - ?Y <br />Address of facility: 5" 7 ° c/u /VU- <br />I am providing a booth with the following: (to protect my unpackaged food aricl food-preparation areas from fes <br />dust and the public) <br />0 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 /> Other (specify):___________________ <br />meats, tamales, cooked beans, rice, <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />J6-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />The following is information about my organization/business: <br />Name of organization/business: O C <br />o -L- C <br />"5^3 O - A y^Altemate: ( <br />List food to be sold or given to the public: /kP/ Do A S