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Environmental Health Department <br />1. <br />2. <br />'K ' <br /> <br />Phone: <br />List food to be sold or given to tho public:..3. <br />4. <br />5. <br />6. <br />| | On- site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />II MP I VI Nl API* <br />7. <br />8. <br />Alternate: ( <br />______ <br />SAN JOAQUIN <br />COUN TY <br />( ; .. .. ! : l < . <!| <• ii- 111-1 ■. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />18681:. Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464 0138 | www.sjcehd.com <br />I I 11)16 02 I ,nfl° '/ Of H II 'MP l-.V! :N I <br />07/3/1 / <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: J:01?’GRAPE FESTIVAL ...Date(s): 12;15:2024 <br />ire tho hot and cold holding of potentially hazardous <br />| | Sterno & hotel trays <br />| | Steam table & lids . <br />(iT^ther (specify) c <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: [_| Yes | 4Tlo <br />All food is prepared on-site or is from approved commercial facilities: TVes No <br />Name of facility: - phone: ------- <br />Address of facility:.Il ..Q/l <br />I am providing a booth witfi the following: (to protect my unpackaged food anti food-preparation areas from flies, <br />dust and tho public) <br />[ | A booth with walls and ceiling constructed of cither wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cloanablo floor (concrete, <br />asphalt, clean tarps and smooth wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. v , <br />(pother (specify): □Tn J/JOTS 4 < t - ■/ <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 bo provided in my booth by the following methods: <br />| :<TApprovod bottled water. <br />I ..I Other (specify): <br />Electricity is provided for my booth's use: I I Yes | TNo <br />I am providing an accurate probe thermometer to moa$jp <br />foods during all times of booth operation: Yes IrfTw <br />I am providing the following hot temperature control for tho hot holding of all potentially hazardous foods above <br />135°F: <br />| | Camp stove <br />| | Double steamer <br />[ | Eloctric stove top <br />The following Is information about my organization/businoss: <br />Name of organization/business:- <br />Address: