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Environmental Health Department <br />Date(s): <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />1 <br />5. <br />( <br />6. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7tf 11 <br />SAN JOAQUIN <br />------COUNTY------ <br />8. <br />9. <br />... <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 I F 209 464-0138 I www.sjgoVjOrgfehd <br />EHD 1MB Page 7 rf 11 <br />07/01/2024 <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. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: yYVMVM \ C4 <br /> <br /> (^03^'_- Alternate: ( )----------------------------------------- <br /> <br />List food to be so!d or given to the public:, frW <br />I am providing food that is NOT prepared at homeQ Yes e/no <br />All food is prepared on-site or is from approved commercial facilitiesQ Yes 0 No <br />Name of facility: ------------------------------------------------------------------Phone: L- <br /> <br />fam prodding a^’ooth 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 />areas from the public. <br />Other (specify): yp 4&0V ___________________________ <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 />QI Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />SfOther (specify): ------------—-— ----------------------------—------------- <br />ETamC'^d^g an aSuratepro'be2 thermometer tomeasure the hot and cold holding of potentially hazardous <br />I ^providing tt^foJtoXghot'temperaturecontrol for the hot holding of all potentially hazardous foods above <br />ISST: Camp st ove Stemo & hotel trays Steam table & lids <br /> Double steamer D Other (specify) <br /> Electric stove top <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.