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DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />„ofj.},11:4 <br />2 — <br />ASIL041'1, <br />SAN,,,JOAQUIN <br />COUNTY — <br />Great <br />REC-008 <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <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 />(Music in the Park, Juneteenth, 4th of July 5/18, 6/15, 7/4 <br />1.Name of Event: Date(s): <br />The following is information about my organization/business: <br />A Little -bste of Culture <br />Name of organization/business: <br />Address: 445 N. Lafayette ct. Mtn. House Ca <br />2098142554 Phone: Alternate: <br />List food to be sold or given to the public: Soul Food with some classics such as chicken Sandwich and <br />I am providing food that is NOT prepared at home: Yes II] No <br />All food is prepared on-site or is from approved commercial facilities: E Yes El No <br />Name of facility: Phone: <br />Address of facility: <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 />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 />Other (specif • Food Truck <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />El Approved bottled water. <br />El On-site hose bib that is connected to a potable water source. <br />Food Trailer Water tanks <br />c-A' Other (specify): <br />Electricity is provided for my booth's use: E 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 111 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove Sterno & hotel trays <br />El Double steamer Steam table & lids <br />11 Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org "ehd <br />END 16-02 Page 7 of 11 TEMP EVENT APP <br />06'19119