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Environmental Health Department <br />Our Lady of Fatima Society of Thornton1.Name of Event: <br />2.The following is information about my organization/business: <br />Name of organization/business: (~)ur Lady °f Fatima Society of Thornton, CA. Inc <br />26590 N Sacramento Blvd Thornton, Ca 95686Address: <br />(Phone:Alternate: ( <br />Linguica, Hot Dogs, Fish, Donuts, Portuguese Sweet Bread3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />6. <br />Electricity is provided for my booth's use: K] Yes No7. <br />8. <br />9. <br />potentially hazardous food include: <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 />0 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 <br />preparation 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 /> Stemo & 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 of 11 TEMP EVENT APR <br />08/14/2026 <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 />Note: Examples of <br />vegetables, potato salad, eggs, and dairy products. <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 /> Double steamer <br /> Electric stove top <br />Date(s)’ 10/16/2610 10/19/26 <br />SAN JOAQUIN <br />COUNTY-— <br />Crrotn-’Si grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br /> Other (specify): <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: £3 Yes No <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: K Yes No <br />Name of facility:Phone: () <br />Address of facility: <br />j 209-745-1096 <br />meats, tamales, cooked beans, rice, <br />j 209-712-3683