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Environmental Health Department <br />i. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />( <br />List food to be sold or given to the public: <br />SAN JOAQUIN <br />COUNTY <br />nrowi here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklis <br />the festival coordinator th ree (3) weeks prior to this event. <br /> 1.Name of Event: MArJ TgCA pv'rW P Z\ vJ ----------Date(s): pcT H <br />unpackaged food and food-preparation areas from flies, <br />F^r^xovidin^ar1 acSraTe probe Vermometerto^measure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation: Qres 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 O Steam table & lids <br /> Electric stove top Hother (specify) /J / <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br /> Other (specify)________________________________________ <br />wam- Thp onlv operations not required to provide enclosed booths are those which sell beverages from <br />approved c ispensers, or prepackaged foods from approved sources. <br />Approved water fa drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottl 3d water. <br />[^On-site hose bb that is connected to a potable water source. <br />The following is information about my organization/business: \ <br />Name ofnrnani.efon/business: VU G CO >4 CESS.I O rU S I <br />373*8 ST- —Ca- — <br />3 f (g O 3^ &Alternate: (---------------- <br />4- VYTpA ------------------------ <br />I am providing food that is NOT prepared at home: Efves No <br />All food is prepared on-site or is from approved commercial facilities: M Yes No <br /> e.t-rc Phone: ( ) <br />Name of facility: ______ -------------------------------------------------------- <br />Address of facility:_______________ <br />I am providing a bDoth with the following: (to protect my <br />dusi and the public) <br />aXlt clean Ws and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.