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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event: <br />2. <br />Bacondogg <br />Phone: <br />3. <br />5. <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />moats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br /> Other (specify):_________________________________________________________ <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 />□^Approved bottled water. <br />02 <br />Environmental Health DepartmentSAN JOAQUIN <br />COUNTY <br />Date(s): frOb <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHO 1S-02 7 o*11 <br />07/01/2025 <br /> Other (specify):_ z —----------------------------------------------------------------------------- <br />Electricity is provided for my booth s use: Q^ves 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: Hres No <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 Stemo & hotel trays <br /> Double steamer Q^Steam table & lids <br />Q Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />List food to be sold or given to the public: VWy £3. f? Scyttx <br />I am providing food that is NOT prepared at home: Sfves No > <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility:Phone: (I----------------------------------- <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 />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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Name of organization/business: \ CJW ,\\ xA p <br />Address: U£l24T)L| __________ <br /> ^Alternate: ( Q| - I <^3^ <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist tn <br />the festival coordinator three (3) weeks prior to this event. <br />The following is information about my organization/business: