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Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />1 <br />5. <br />6. <br />•• 9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />COUK•v <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 • J TEMP EVENT APP <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 />Q On-site hose bib that is connected to a potable water source. <br /> Other (specify):____ ______________ ______________ <br />Electricity is provided for my booth's use: Yes 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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />eZired t0 re,Um a Si9ned and “mpteted <* ■«-> <*«*■« •o <br />I.Name of EventtHwwH D,w,1; <br />The following is information about my organization/business: <br />Name of organization/business: Ar <br />Address: (Lr. <br />PhOne: Alternate:^ <br />List food to be sold or given to the public: pi Sti f I f <br />I am providing food that is NOT prepared at home: V] Yes □ No ~ <br />All food is prepared on-site or Is from approved commercial facilities: 0Yes No <br />Name of facility: Phone- (. <br />Address of facility:_ T^r S', - <br />' 8 M°\h With lhe fo,,0W,n9: (t0 P'°teCt my ^Packaged food and food-preparation areas from flies, <br />□usi ano tne public) <br />SJIahT Wlth |V?II|S and I00'!'”9 const^cted 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 />areas frorrTthe^ubflc3^ SmO°th W°Od are accePteble) and constructed to separate food and food preparation <br />Ef Other (specify):____________________