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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />cAAddress:-j- <br />Phone:) <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />O On-site hose bib that is connected to a potable water source. <br />9. <br />TEMP EVENT APP <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />SfApproved bottled water. <br />meats, tamales, cooked beans, rice, <br />SAN JOAQUIN <br />COUN- <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | 'uvww.sjgov.org/ehd <br />EHD 16-02 PaO0 7 a 11 TEMP EVENT " <br />07/01/2024 <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: No <br />Name of facility. ydyvn ft/S YPdvVtV ______Phone: (, ) <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 />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 /> Other (specify): .________________________________ <br />Electricity Is provided for my booth's use: |X[ 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: KJ Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: M <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples off potentially hWua YoMiudo: <br />vegetables, potato salad, eggs, and dairy products. <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 />1.N«ne of Event/f/m4/Z/ OfiM_____________Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: fclB> 2 <br />O-T- yttfrctc fed , i poYi <br />(^0 *( ) ~ U 3 Alternate: ( <br />List food to be sold or given to the public: V€X#S>