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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1.Date(s): <br />2. <br />V^-VX <br />Address: <br />2x^; ^7^ <br />3. <br />4. <br />5. <br />6. <br />On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9. <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />M Sterno & hotel trays Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />COUNTY <br /> A booth with walls and ceiling constructed 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. j <br />tfO'her (specify): <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 />I^fves □ No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <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 /> Other (specify): /_____________________________________________________ <br />Electricity is provided for my booth's use: [3 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:LJ Yes [I No <br />I am providing the following hot temperature controTfor the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp st ove <br />0 Double steamer <br /> Electric stove top <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 />The following is information about my organization/busmess: <br />Name of orqanization/business: <br />3/^ LV !-« S <br />Phone: (2^) 5 <7 2- ___ Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:[^Yes □ No <br />All food is prepared on-site or is from approved commercial facilities: »i i inu <br />Name of facility:~?~3^ f Phone: ( O6/) ~7 ( <br />Address of facility: C Vf p (V\^ /V <br />I am providing a booth with the following: (to'-protect my unpackaged food and food-preparation ar^as from flies, <br />dust and the public)