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Environmental Health Department G TEMPORARY FOOD VENDOR’S APPLICATION Date(s): ^^^-31.1. Name of Event: 2. Address: Phone: 3.List food to be sold or given to the public; 4. 5. acrx 10<- 6. -p 9. meats, tamales, cooked beans, rice, Sterno & hotel trays Steam table & lids Other (specify) 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 of 11 TEMP EVENT APP 06/29/2023 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. SAN JOAQUIN COUNTY I am providing food that is NOT prepared at home: All food is prepared on-site or is from approved commercial facilities: ^3 Yes No Or> SH Name of facility:Phone: ( ) Address of facility: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) I Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. ------------------------- eft T^-sa/f Alternate: ( 2(07) 993r S-(p 3 the public^'^'4' Cr-^cr rCx crua. Choco Ia.4^ / oof3?e. ctlloujec/ ' _ ' ............ . . ' ' ' V^Yes No immercial facilities: 53 Yes No - Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: jZ] Approved bottled water. On-site hose bib that is connected to a potable water source. ’E3 Other (specify):. (V) (T Q 7c J po 1 QU /Electricity is provided for my booth's use: Yes 13 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: 0,Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove Double steamer Electric stove top The following is information about my organization/business: Name of organization/business: CclaI-s I n 11 l—Q <4 UGru 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. C-V) y vsVrn q 5 '■ Coneys (p 42)c.