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Environmental Health Department <br /> <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event:Date(s): <br />2. <br />Address: <br />Phone:Alternate: () <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 I www.sigov.orq/ehd <br />Pa9e 7 11 TEMP event AfTEMP EVENT APP07/01/2025 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />SAN JOAQUIN <br />C O U N T Y <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[v^pproved bottled water. <br />Name of organization/business: <br />1 4 <br />) <br />are required to return a signed and completed copy of this checklist to <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0'Yes No j <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: ( J W / __________Phone: (4^ <br />Address of facility: (//7i2 S a?/Yp lath f C <br />I am providing a booth with the following: (to protect my'unpackagea food and food-preparation areas from flies, <br />dust and the public) <br />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 />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 />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />/!/ ly He* Uh <br />The following is information about my organization/business: <br />^£>^*4 Aw c'l___')f~' <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):__ /___________________________________ <br />Electricity is provided for my booth’s use: Yes 0 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 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 Stemo & hotel trays <br /> Double steamer H'steam table & lids <br /> Electric stove top Other (specify)