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Environmental Health Department <br />All food vendors (both foi profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1. Name of Event:1. <br />2. <br />Address: <br />Alternate: ((Gtt)Phone: <br />List food to be sole or given to the public:3. <br />4. <br />5. <br />required to provide enclosed booths are <br />6. <br />9. <br />,j/a <br />7. <br />8. <br />4 I <br />Q Approved dotted water. <br />Q'On-site hose tib that is connected to a potable water source. <br />) <br />CA <7 ^4 3— <br />the festival coordinator tlvee (3) weeks prior to this event. <br /> 9TP€<r7 feoate(s):Lc <br />SUN .OAQUIN <br />C C U N 1 Y <br />< ruf n.'1.■ <|i <nv»i ;ir/ (’ <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />1868 E. Hazelton Averue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sigov^orgfehd <br />Panp 7 nf 11 ' EMr cvci'i i nrrEHD 16-02 Page 01 <br />07/01/2024 <br /> Other (specify;:--------------------------------------------------------------------------------- <br />-.u . not reouired to provide enclosed booths are those which sell beverages fromNO,e: approval XeS. o^Xed foods from approved sources. <br />Approved water far drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Electricity is provided for my booth’s <br />I am providing a« < <br />foods during all times of booth operation. <br />I am providing the following hot temperature <br />135°F <br /> Camp stove , j Sterno & hotel trays <br /> Double sleanisr > Steam table & lids <br /> Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />meats, tamales, cooked beans, rice, <br /> <br /> Other (specify.: _____—--=^es n Nq <br />Accurate probe iharmometarto measure the hot and cold holding of potentially hazardous <br />imes of booth operation: QYesD, No foods above <br />The following is information about my organization/business: <br />Name of organizaton/business: CO >>*0 <br />Sst. eAsr <br />8/^ 029 6 <br />L Otvi c Ape f <br />I am providing food that is Npl prepared at home:&Yes No z <br />All food is prepared on-site or is from approved commercial facilities: 0’Yes No <br />Name of facility: -------------------------------------------------------------------Phone. £ ) <br /> <br />areaS from flieS' <br />dust and the public) <br />^hootb with watts and <br />“9cie?nXeandnsCmoS^ Xd a°ro acceptab.e) and constructed to separate food and food preparat.on <br />areas from the pu olic.