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304 $ SO5 <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Address: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />I <br />F 209 464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />7. <br />8. <br />SAN JOAQUIN <br />COUNTV <br />are required to return a signed and completed copy of this checklist to <br />event. <br />1 Name of Event: Gly ig+frsgs. H'V 'f'Q r II <br />are those which sell beverages from <br />Q On-site hose bib that is connected to a potable water source. z-x , v » <br />pother (specify); VCH-L1 f 4TC^'/\ O 4L 4a«.' I1 tCbAe.r <br />Electricity is provided for my booth's use: M 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: J^Yes No <br />1 a^5P°l|?Vidin9 thG following hot tcmPcra,ure control for the hot holding of all potentially hazardous foods above <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top pother (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this <br />1. <br />Note: The only operations not required to provide enclosed booths <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 /> Approved bottled water. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 <br />EHD 16-02 Pago 7 of 11 <br />07/01/2024 <br />meats, tamales, cooked beans, rice, <br />Date(s): 1^-/6/^-^ <br />The following is information about my organization/business <br />Name of organization/business: 06 £16- -Pam <br />Phone: Alternate: ( )________ <br />List food to be sold or given to the public: ^ako.gl Po'j'ZrMf vr/ <br />I am providing food that is NOT prepared at home: £^Yes No <br />All food is prepared ontsite or isrfrom approved commercial facilities: BL Yes No <br />Name of facility: phone: 1 I <br />Address of facility: -) VGcll n HWfVlSLcPX CA Cj _______ <br />I am providing a booth with the following: (to protect my unpackagedfood and food-preparation areas from flies <br />dust and the public) <br />JJ'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 />areas fronTth0 ^bf Sm°Oth W00cl are acceP,able) ancJ constructed to separate food and food preparation