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TEMPORARY FOOD VENDOR’S APPLICATION <br />08/29/2026 <br />696-1079 rno-’e 209 <br />J =■ j p eparatiu' areas frani f’l-a.- <br />X O:Hc?r sr sc ' ,, 10X10 canopy with side walls <br />Y. Apa-oved oor/ed .vatar <br />~T Cn-si‘.e hose oib that s ccmec'.ec to a potab e ater source <br />Oyer 'spec r'y,- <br />"lec’/.c.ty is provided for my bcotr’s use i Yes ^7 Na <br />? <br />meats, tamales, cooked beans,nee. <br />Faj-1 7 <br />Mote: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved cisoerse's o' preoackacec "pcs ‘-pm appro.ed sources <br />1 ani prc. d ng food re-, s NOT 'zroco-cc ot ’■o- ~X v •-<; ' \o <br />Al’ food ? orepared or s te or is '■ .■m ?.[ ye ved commeroia foe •.! <br />Na~e cf foe ’ iy,_______________ _ <br />Address of facility: <br />Sts'no S -ot-il-.-a .s <br />TJ Steam table & i os <br />JJ Otne- • specs.) <br />I am providing a booth with fl epvyirg ftp protect my unpacl <br />d.,s: and the pub ci <br />Dirty Sodas, Flavored soft drinks, Red Bull <br />Beverages.cream based soda drinks bottled <br />drinks/water,---------------------------------- <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I 5m c-pvi: ng the fol ov/rg hot tempe'at. '= cor“rol ’’o' the "o: cold -g -■ all ppfemia Iv h-.-’p-dous foods aoc .e <br />135-T. <br />I Cts'-up stove <br />E? Cc.ce stea'-er <br />~ " ec," c stove too <br />L. A boot1-1 with .vails end os -g ccmst-uoted of er.-er .vood calves piest c. simi er meter s. ?md re mesa fy <br />screening completely er'oos ng open food a--..ns I: .v I. also rave s smooth arc cleanaoi- -loo- (concrete <br />asphalt mean tarps and smooth wend are acceptable? and const-jcteo to sepsmte food and feed p'eps'ation <br />areas f'om the publ'd <br />i'i e f" nr/ ng s rmc-mator. about my omamzation nusmess <br />Name organzaton c. s n:>5 Country Club Automated Retail LLC DBA Country Club Vending <br /> 2250 Delaware Ave Stockton Ca 95204 <br />Apo-cved water for d'in<ing utens ard na-d .-.as-irg I' ce o'o.ced in -y z; me :z oz.-mg memocs <br />I am providing ar accurate erode thermometer to measure tne mt ard cold -olc.-rg z: potentially irazameus <br />'oods du- ng all times of oootn ope-aticn. Yes P No <br />All food vendors (both for profit and nph-profit) are required to return a signed and completed copy of this ■J list •? <br />rhe 4est va cor-rdinator three (3) weeks p' or to this event <br />- v .. -Stockton Tequila fest 2026