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SAN J O A U U I N Environmental Health Department COU NTY -- TEMPORARY FOOD VENDOR'S APPLICATION vendors both for profit and non- rofit are required to return a signed and completed copy of this checklist to All food ( p non-profit) q g the festival coordinator three (3) weeks prior to this event. 1I � 122 4 � ASGrff�� 1. 1.NameofEvent: -i?r�r �tY•�C� 3��c,Y1f � GU�� {� �`��Date{s): 7r / S�15 —' (�� 2. The following is information about my organization/business.- Name rganizationlbusiness:Name of organization/business: J r('tr�� Address: Phone: (fin ) f 3 , � Alternate: ( ) � 61 3 �f7 G(l ,>'j 3. List food to be sold or given to the public: f 4. 1 am providing food that is NOT prepared at home: Yes ❑ No All food is prepared on-site or is from approved commercial facilities: ❑Yes ❑ No Name of facility: f�t,h 5 l r{�fc-a, c�c�Il f S (u fie,-t '- Phone: (:'' Address of facility: ' ? /t�' �' `r 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify): p Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources 6- Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. ❑On-site hose bib that is connected to a potable water source. E]Other (specify): PC l4y_" tJ t- r/` (�,/,�, / 7. Electricity is provided for my booth's use: ❑Yes ❑ No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: F] Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑ camp stove ❑ Sterno 8, hotel trays ❑ Double steamer ❑ Steam table& lids ❑ Electric stove top ❑ Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd EHD 16-02 Page 7 01 11 TEMP EVENT APP 07/01/2025