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S A N J O A Q U I N (Environmental Health Department <br /> L(D1...1N1 .1. Y <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: 4th Annual Chicano Community Program Radio Reunion&Car Show Date(S): 9/9/2018 <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: KXVS The Voice of Stockton <br /> Address: 231 Bedford Rd, Stockton,CA 95204 <br /> Phone: ( 209 ) 467-4455 Alternate: ( 209 ) 740-7956 <br /> 3. List food to be sold or given to the public: Tamales, beans&rice <br /> 4. 1 am providing food that is NOT prepared at home: Fx_1 Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: 0 Yes ❑ No <br /> Name of facility: La Yolanda Restaurant&Bakery —Phone: ( 209 ) 464-2240 <br /> Address of facility: 2860 N California St,Stockton, CA 95204 <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 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 /> 0 Other(specify): Boat House facility with kitchenette <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 /> 0 Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: 0 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: Fx_1 Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove 0 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 salad, eggs, and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 07/3/17 <br />