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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />Phone <br />3.List food to be sold or given to the public. <br />4 <br />5 <br /> Other (specify): <br />those which sell beverages from <br />6 <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />SAN JOAQUIN <br />-----COUN'Y <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />. --------------» food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Ha2elton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov.org/ehd <br />06/29/2023 7 11 TEMP EVENT APP <br />Date(s) 2 <br /> On-site hose bib that is connected to a potable water source. <br />t^Other (specify): _________________ <br />Electricity is provided for my booth’s use Yes O 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.PTNo <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />_ >35 F. <br /> Camp stove stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top JZfOther (specify) S\ <br />Note: Examples of potentially hazardous <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 Name of Event O (? sU Hott’ 20^-1 <br />The following is information about my organization/business: <br />Name of organization/business: f ft ui iVtx' 1/C H L t C <br />Address: <br />/?73) ^20^' <br />ft q.vu: <br />Jax/ ivw.y QJ\ <br />Alternate:(2OS 7 <br />(.tl 0 <br />I am providing food that is NOT prepared at homexZf Yes No <br />All food is prepared on-?itg or is from approved commercial facilities<^YesJ^INo -CA <br />Name of facility-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 />.J^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.