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Environmental Health Department Date(s): Q 9'3I.Name of Event:1. 2. cAAddress: Phone: [i 3.List food to be sold or given to the public: 4. 5. 6.I 9. 5 ■ I I I ■ I 7. 8. 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd EHD 16-02 Page 7 o( 11 TEMP EVENT APP 07/01/2026 I I II 5 SAN JOAQUIN ------COUNTY------- Grealness grows here. TEMPORARY FOOD VENDOR’S APPLICATION A I f&A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 5 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: y} Approved bottled water. On-site hose bib that is connected to a potable water source. . . M Other (specify): Electricity is provided for my boatd’s use: [YYes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Kfl Yes No I am providing the following hot temperature'control for the hot holding of all potentially hazardous foods above 135°F: Camp stove Stemo & hotel trays Double steamer Steam table & lids , / / f\ /')/'' Electric stove top pother (specify)SI^ £ Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. I am providing food that is NOT prepared at home: t^Yes No All food is prepared on-site or is from approved commercial facilities Yes No Name of facility: tX-ZVyh H /Utf Or "n k Phone: (2^) Address of facility:, /77T- tirrl- (<A I am providing a booth with the following: (to protect my unpackaged food and f^pd-preparation areas from flies, dust and the public) All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. /Vk/rn l( Fa lr/ The following is information about my organization/business: Name of organization/business: 1^,11 4 m (20*?) Alternate: (