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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. <br />2. <br />Phone: <br />■>3. <br />4. <br />5. <br />6. <br />9. <br />a2//x <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />7. <br />8. <br />Alternate: (6 b I ) <br />SAN JOAOUIN <br />COUNTY <br />< •! i’<itne .s ipoiv* hi'i c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Paoe 7 0,11 TEMP EVENT APP <br />07/01/2024 <br />the festival coordinator th ree (3) weeks prior to this event. <br />1. Name of Event: MAix) <br /> Other (specify)____________________________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved cispensers, or prepackaged foods from approved sources. <br />Approved water fcr drinking, utensil and hand washing will be provided in my booth by the following methods: <br />The following is information about my organization/buslness: <br /> Name of organizalon/business: G 0^ S Q <br /> Address: 7 S > S S71 EAST Lt <br /> (6G I) fe> 03^ 8 Alternate: (66i )I(g- ----- <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: ^Yes No <br />All food is prepared on-site or is from approved commercial facilities: M Yes No <br />Name of facility: ON S'T(s Phone: (-------)------------------------------------- <br /> I am providing a Loth with the following: (to protect my unpackaged food and food-preparation areas from flies? <br />dust and the public) <br />f/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 />[~| Approved bottled water. <br />[^On-site hose bb that is connected to a potable water source. <br /> Other (specify^------------------ ---------—/ —------------------------------------------------------------------------------ <br />Electricity is provided for my booths use: [FYes UNo <br />I am providing ar accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation: M Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer D Steam table & lids <br /> Electric stove top H'Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.