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Environmental Health Department <br />'o1.I.Name of Event:Date(s): <br />2. <br />Name of organization/business: <br />Address: El <br />7? / y1/2,0^Phone:()Alternate:() <br />3.be the public: <br />4. <br />Address of facility: <br />5. <br />Other (specify): <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Other (specify): <br />7. <br />8. <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 />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <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 12 TEMP EVENT APP <br />07/01/2025 <br />The following is information about my organization/business: <br />SAN JOAQUIN <br />COUNT Y------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Electricity is provided for my booth's use:^Yes □ 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 />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist <br />to the festival coordinator three (3) weeks prior to this event. , <br />'^Approved bottled water. <br />SfOn-site hose bib that is connected to a potable water source. <br />List Q^food to be sold or given to <br />'To £ \ R ieftecfio <br />I am providing food that is NOT prepared at home: Yes No . <br />Q__AII fp.od is prepared on-site\jr is from approved commercial facilities: □ Yes Wno <br />Name of facility:Phone: X )