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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />*75^ 7 T <br />Phone: <br />3.List food to be sold or given to the public: <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 methods:6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />A 7. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />A/ <br />/v A 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 />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />COUN’ <br />AyA 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 />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.otg/ehd <br />EHD 1&-02 Paae 7 of11 TEMP EVENT ** <br />07/01/2024 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />are required to return a signed and completed copy of this checklist to <br /> Date(s): <br /> Other (specify):__ <br />Electricity is provided for my booth’s use: 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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />I am providing food that is NOT prepared at home: JSJ Yes No <br />All food Is preparedon-site or Is from approved commercial facilities: 0 Yes No <br />Name of facility: Phone: <br />Address of facility:. Z/22a/£- 4 ./WzUz <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 /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material andfinemesli fly--------- <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of EventMfiUirrAffij Jhjsfc CW <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: <br />( 3//? ) 6? 5^ f Alternate: ( ) <br />z/ /v( ^^5