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Environmental Health Department <br />(, •. <br />1. <br />2. <br />) <br />3. <br />4. <br />5. <br />(>. <br />9. <br />meats, tamales, cooked beans, rice, <br />Cooe <br />____ <br />7. <br />8. <br />SAN JOAQUIN <br />COUNIY <br />ii •. •. • ■. het- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />| | Approved bottled water. <br />On- site hose bib that is connected to a potable water source. <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 />1. Name of Event:. L0DJ ^S.T,VAL <br />[ | Other (specify):,, ---------------------------------- ---- -------------- ----------------------- <br />Electricity Is provided for my booth's use:M Yes | I 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: L J Yes | J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />I | Cam])-stove I I Storno & hotel trays <br />| | Double steamer I'.I Steam table & lids <br />| | Electric stove top T. I Other (specify) <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 I: I lazellon Avenue | Stockton. California 952.05 | T 209 d68 3420 | I 209 464-0138 | www.sjcehd.com <br />I UD 16.02 PaflO /oMI U MP EVI Nl APP <br />(I//3/I7 <br />Datefs): SEP 12-15,2024 <br />The following is information about my organization/business: <br /> Name of organization/business: — <br />Address: .GflA <br />Phone: (9$l ) Alternate: ( <br />l ist food to bo sold or given to the public: . _C.X £<&££>--------- <br />I am providing food that is NOT prepared at homo: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: |/fYes LI No <br />Name of facility: Phone:.(-----)----------------------------------- <br />Address of facility: —------------------------------------------------- — <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />J/fA booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />’screening, completely enclosing open food areas. It will also have a smooth and clcanablo floor (concrete, <br />asphalt, clean tarps and smooth wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />j<fbthcr (specify):. |___________________—....... - -------------------------—------ <br />Noto: The only operations not required to provide enclosed booths arc 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: