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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.1. Name of Event:Date(s): 6/19/26 <br />2.The following is information about my organization/business: <br />Name of organization/business:■Delroysdeli <br />Address:Rough snci <br />Phone:) 4633968 ) 9151415 <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />LJ Other (specify): <br />6. <br />EJ On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br /> Other (specify): <br />Electricity is provided for my booth’s use: EJ’Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />E} Approved bottled water. <br />EJ Sterno & hotel trays <br />El Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />------COU NTY <br />Rice and vei <br />igh inland Stockton ca 952(13 <br />are required to return a signed and completed copy of this checklist to <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/3/17 <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />( 209 <br />foods during all times of booth operation: E}'Yes 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 <br /> Double steamer <br /> Electric stove top <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 />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 />I am providing food that is NOT prepared at home: EJ Yes No <br />All food is prepared on-site or is from approved commercial facilities: EJ Yes No <br />Name of facility: nelrnysdeli ___________________________Phone: ( 909 )46.33963 <br />Addressoffacility: Rough and rough island h17 hnxBstnckton ca 952Q3 _______ <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 />Parthday 2026 <br />Alternate: ( 209 <br />'ggip ,howls fried asparagus .onions rings fries .garlic fries