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Environmental Health Department <br />I.Name of Event:1. <br />2. <br />Address: <br />Phone: <br />J-3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Other (specify):__________ _______________ <br />Note: The only operations not required to provide enclosed booths <br />SAN JOAQUIN <br />COUNTY <br />Greatness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton. California 95205J 1,209 468-3420 | F 209 464-0138 | www sjgov <br />07/01/2024 <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 />Date(s): <br /> Other (specify):_—------------ <br />Electricity is provided for my booth's use: Yes LJ No <br />I am providing an accurate probe thermometer to measure <br />I a’mprovSng hot holding of all potentially hazardous foods above <br />135°F: , <br />^^Camp stove D Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All 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 />vA.^yv .sVH-eV <br />The following is information about my organization/business: <br />Name of organization/business: yA-fityj/Pl Y-----LO C.C4..S.----------------------- <br /> <br />12,41 5- ^£36 (_______ <br /> ( ) 7,^ - 3 ^4 3 Alternate: ( ) <br />List food to be sold or given to the public: CllpS. <br />I am providing food that is NOT prepared at home:fl£| Yes No <br />All food is prepared on-site or is from approved commercial facilities:(p Yes No <br />Name of facility: VA. CIX J ----------------------Phone. (--------)— <br />Address of facility: V —AS3&-----------— ------ <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 />(Aa booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />keening, 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.