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Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <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 />135CF: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />SAN JOAQUIN <br />COUN • <br />Woe <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are ‘ <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): ,_________________________________________ <br />Electricity is provided for my booth's use: n Yes PrNo <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 />are required to return a signed and completed copy of this checklist to <br />I.Name of Event <br />The following is Information about my organization/business: <br />Name of organization/business: 5^^) CyS>(X \o<A <br />Address; ^^2^1 K <br />Phone: Alternate: ( ) <br />List food to be sold or given to the public: 3Al5A 4 <br />I am providing food that is NOT prepared at home: ^<es No <br />All food Is prepared on-site or is from approved commercial facilities:^ Yes No <br />Name of facility: LA /tfCi&WA TA(yEA|Pr Phone: ( 7^ <br />Address of faculty: 95320 <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 />Q^Abooth with walls and celling 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):___________________________________________________________