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Environmental Health Department <br />! <br />1. <br />2. <br />i <br />3. <br />4. <br />I <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meati, tamalet, cookad baana, rica, <br />TEMP EVENT APPPeoeTortl <br />! <br />136’F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 15*02 Paqo f of 11 , A! <br />07/01/2025 <br />Electricity is provided for my booth's use: Q Yes No <br />foods during all times of booth operation: Yes KbNo <br />I am providing the following hot temperature control for the <br /> Sterno & hotel irays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardoue food Include: <br />vagetables, potato salad, eggs, and dairy products. <br />MBiSANJOAOUIN <br />/-----C OU NT Y----- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> A booth with walls and celling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It wlH 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 />Mother (specify): / /~/A|/^. <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 />I am providing food that is NOT prepared at home:^i-Yes No <br />All food Is prepared on-site or Is from approved commercial facilities: No <br />Name of facility: <in’./-/^»hone: (2^?) OOg ~ 60?^ <br />Address of facility: ft S. /F <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and ths public) <br /> On-site hose bib that Is connected to a potable water source. <br />g^Other (specify): H(9T LU AT&/£~. L? I ________________________________ <br />___r.,.: _ „:_______, ___22“ LZ“» <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Showing of alCpo&^lly hazardous foods above <br />The following is information about my organizatlon/buslness: <br />Name of organization/buslnessi'THA'T* Z-Z-^C-_______________________________ <br />Address: /ll LL 2 <br />Phone: (2^9) Alternate: ( ) <br />List food to be sold or given to the public: <br />AH 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: CE