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SAN JOAQUIN Environmental Health Department COUNTY TEMPORARY FOOD VENDOR'S APPLICATION 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. 1. 1. Name of Event: A-J'A Date(s): June 10, 2023 The following is information about my organization/business: Name of organization/business: Kona Ice of Ripon Address: P.O. Box 1371 ) 407-7044 Phone: ( 209 Alternate: ( 209 ) 318-6078 3. List food to be sold or given to the public, Shaved Ice and Flavors I am providing food that is NOT prepared at home: El Yes LI No All food is prepared on-site or is from approved commercial facilities: EYes No Union Catering Truck Center Name of facility, Phone: ( 209 ) 298-5416 Address of facility: 1717 South Union Street Stockton Ca. 95206 I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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"-- El Other (specify), Truck "— Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: El Approved bottled water. LII On-site hose bib that is connected to a potable water source. Other (specify): 7. Electricity is provided for my booth's use: ElYes 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: II] Yes No 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: El Camp stove EISterno & hotel trays LI Double steamer El Steam table & lids El Electric stove top E Other (specify) Nothing Hot Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products. 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd EHD 16-02 Page 7 of 11 TEMP EVENT APP 06/19/19 3 compartment sink / 1 hand washing sink / storage tank on truck