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SANJOAOUIN Environmental Health Department <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <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 />Yes No <br />to measure the hot and cold holding of potentially hazardous <br />[D'Sterno & hotel trays <br />[j^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 of 11 TEMP EVENT APP <br />07/01/2025 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />HfApproved bottled water. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />[Efbn-site hose bib that is connected to a potable water source. <br /> Other (specify): /______________________________________________________ <br />Electricity is provided for my booth's use: [/Yes No <br />I am providing an accurate probe thermometer to measi ~ . ' <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 <br />0 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 />1. Name of Event: * <br />List food to be sold or given to the public: . <br />-A IK f /"odqF <br />I am providing food that is NOT prepared at home: [3?Ves No n Aafc: c <br />All food is prepared on-site or is from approved commercial facilities: O No <br />Name of facility: C1 Sy Phone: ( ) <br />Address of facility: C( 6^ If <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) <br />Q^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 />■ COUNTY <br />%.yFOp-^' Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is information about my organization/business: <br />Name of organization/business: (S< (^7 <br />Q I 0 LxJ - M Q CC ty ^-0 <$-4 9 Z -7 <br />__________Alternate: yZc/?) 1- 7-c)7- d <br />—1 * b Zixl a k <br />s 'Pq.s-Cri-e?< -wIz r o -C4 e <br />a Q , P' -a > , (p q r, ( c e <br /> No Ck