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1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />(^Approved bottled water. <br />^fon-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />^7 <br />Environmental Health DepartmentSAN JOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />1 TCI4D C\/CklT AlEHD 16-02 Page7 of 11 — <br />07/01/2025 <br />Date(s): <br /> Other (specify): _______________________________ <br />Electricity is provided for my booth’s use: QYes 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 Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove [JpStemo & hotel trays <br />{xJ-Ttouble steamer IxkSteam table & lids <br /> Electric stove top Other (specify) <br />The following is information about my organization/business: <br />Name of organization/business: A/7? f Z^A/ GSCAMkJ DfJ'/ *>7' [a/'fl' <br />la&i.ca qszvb_________ <br />Osb6! 2 ^3^ Alternate: ($0^). ----------- <br />List food to be sold or given to the public: -noirfLc .n/a^U^'TiAJrPrc/u^ <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: OYes No <br />Name of facility: . Phone: (2^) <br />Address of facility: 4/ S A/- z C/fQ ___ <br />\ am providing a booth witn the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />Q^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. <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: fiAHRKhiMJ KJ£U) ysnK