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Environmental Health Department <br />( <br />Dale(s): 1. <br />2. <br />6 <br />3. <br />4. <br />5. <br />6. <br />: meats, tamales, cooked beans, rice, <br />( <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br />9. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgovxjrg/ehd <br />EHD 16-02 Page 7 of 11 <br />07/01/2024 <br /> Other (specify): _____________ <br />L____ , . <br />I am providing an accurate probe thermomi <br />foods during all times of booth operation.fE <br />I am | <br />135T: <br /> Camp st ove <br />H Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food Include <br />vegetables, potato salad, eggs, and dairy products. <br />Electricity is provided for my booth's us^t^sUNo asure <br />providing thVfoitowTnghot ieTpe^uSoHor the hot holding of all potentially hazardous foods above <br />M*Stemo & hotel trays Steam table & lids <br /> Other (specify) <br />______________________ <br />(zo<f> 754 <br />1. Name of Event:. <br />«The following is information about my organization/business: <br />Name of organization/business: <br />Rhone" ^OQO Alternate: <br />List food to be sold or given to the public:. <br />I am providing food that is NOT prepared at homei^fYes No ✓ <br />All food is prepared on-site or is from approved commercial facilitiesfj Yes O No <br />Name of facility: C-A- h Phone: (2<^) ^6^ ’ 4707--------- <br />Address of facility: 7 ^0 Fp/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 /> 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 />^t)ther (specify): -___________________ <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 />{^Approved bottled water. <br />[^On-site hose bib that is connected to a potable water source. <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 />SAN JOAQUIN <br />------COUNTY------ <br />Gr< atness §row5 f.crt. <br />TEMPORARY FOOD VENDOR’S APPLICATION