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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 <br />2. <br />Address <br />3 <br />4. <br />5 <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />0 Approved bottled water <br /> On-site hose bib that is connected to a potable water source <br />9 <br />7 <br />8 <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 />PCI 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 /> Sterno & hotel trays <br /> Steam table & lids <br />[£] Ollier (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify) _____________________________ ___________________ <br />Electricity is provided for my booth's use: H Yes No <br />I am providing an accurate probe thermometer to measure tire hot and cold holding of potentially hazardous <br />foods during all times of booth operation. H Yes I I No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sigov org/ehd <br />EHD 16 02 Page 7 of 11 TEMP E.VEN1 APP <br />07/01/2024 <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 />I .Name of Event: Date(s) <br />meats, tamales, cooked beans, rice, <br />The following is information about my orgamzation/busmess: <br />Name of orgamzation/busmess: LLC ______ <br />Phone: ( ^l<f \) Alternate: (^^ ) <br />List food to be sold or given to the public: MjasuA* , Aww <br />I am providing food that is NOT prepared at home: ® Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: Pity Phone: ( <br />Address of facility: Z2(L/ 4v<2-- <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)