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SAN JOAQUIN <br /> --COUI\ITY — <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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. 1.Name of Event: Um •-:T Date(s). S/3 & 10/4 2026 <br /> 2. The following is information about my 4 orga(n�lzation/business: <br /> Name of organization/business; 6105 1 11 4H <br /> Address: 1 SN 3 Sit ,Plrr "Ma <br /> Phone: ( `'d t tt) 113_ ..-I 0 0 Alternate: <br /> 3, List food to be sold or given to the public: qila ow S S 01 wAsp <br /> 4 1 am providing food that is NOT prepared at home:❑Yes�<No <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes-,No <br /> Name of facllity: 5 0 Q Phone:1-% ��3.1100 <br /> Address of facilityls43 st uMoAL– &_ t yus E1 -tgtAT� % I o <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with walls and telling constructed of either wood, canvas, plastic,similar material and fine mesh fiy <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. <br /> Other(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 /> 6. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a pot ble wafer source. <br /> Omer(specify):4 oD 4 S d <br /> 7. Electricity Is provided for my booths use:❑Yes❑No <br /> 8. 1 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 /> 9. 1 am providing the following hot temperature control for the hot holding of all potentlaUy hazardous foods above <br /> 135°F: <br /> ❑Camp stove [71 Sterno&hotel trays <br /> ❑ Double steamer []Steam table&lids <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato Galati,eggs,and dalry products. <br /> 1968 E. Hazelton Avenue I Stockton,California 062051 T 209 468-3420 1 F 209 464-0136 [ www.sjcehd.com <br /> EHn iG.02 page 7 of 11 TEMP EVE07 APP <br /> 0713117 <br />