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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />09/05/20261. Name of Event:1.Date(s): <br />2. <br />Address: <br />(PQ9) 397-1241Phone:Alternate: () <br />3.List food to be sold or given to the public: <br />4. <br />397-1241 <br />5. <br />I provide packaged baked goods.Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />iroved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <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 />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 /> Phone: (209) <br />2703 Summerfield Dr, Stockton, Ca 95209 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 o» 11 TEMP EVENT APP <br />06/19/19 <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------ <br />(jrea'.aei'- her-.. <br />^es No <br />Imeter to measure the hot and cold holding of potentially hazardous <br />i-J^'es No <br />irecohtrol for the hot holding of all potentially hazardous foods above <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth's use: <br />I am providing an accurate probe thermop^l <br />foods during all times of booth operation: <br />I am providing the following hot temperatui . <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 />Market 1313 <br />The following is information about my organization/business: <br />Name of organization/business: BdIIQ CefQlU CO <br />2703 Summerfield Dr, Stockton, Ca 95209 <br />I am prdviding food that is NOT prepared at home: Yes Mt No <br />All food is prepared on-site or is from approved commercianacilities: yCves No <br />Name of facility:. My home V <br />Address of facility:. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public)