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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. <br />2. <br />Address: <br />3. <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 />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <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 />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 /> Other (specify) ____________________________________________________ <br />Electricity is provided for my booth's use: Q'Ves No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />The following is information about my organization/business: <br />SUEET-g <br />SAN JOAQUIN <br />COUN"Y <br />Note: Examples of potentially hazardous food include: <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. Name of Event: Hod <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 />135°F: <br /> Camp stove [vf^lerno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />1888 E Hazelton Avenue I Stockton, Cahlornia 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />_ -- . . . iri r-» k it a i <br />EHD 16-02 Page/ of 11 ■—■■■ ....... <br />06/29/2023 <br />I am providing food that is NOT prepared at home: [vj-Ves No <br />All food is prepared on-site or is from approved commercial facilities: B'S'es No <br />Name of facility: /Q 4 sp c J <k /?Phone: (l.^ ) A1 8 <br />Address of facility: T fiXv-xl "~T , C-A <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 />Name of organization/business: <br />^,\|o CM <br />Phone: (7 o -( - S 18 Alternate: ( ) ^ ^ ^ <br />List food to be sold or given to the public: f qJ-C'