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Environmental Health Department TEMPORARY FOOD VENDOR’S APPLICATION Ma/1. 2. Address: Phone: 3. 4. 5. [ ] Other (specify): 6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. 9. meats, tamales, cooked beans, rice, Sterno & hotel trays Steam table A lids Other (specify) 7. 8. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. SAN JOAQUIN . • b. A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and clcanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. /c s ________________ Date(s): Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Other (specify): Electricity Is provided for my booth's use: Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes No I am providing the following hot temperalure control for the hot holding of all potentially hazardous foods above _135°F: I 1 Camp stove Double steamer f l Electric stove top All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this eve.nt. 1, Name of Event: I 1808 E. f lazelton Avenue | Stockton. Calilornia 95205 | T 209 468-3420 | I- 209 464-0138 | www.sjgov.ojg/ehd EHD 16-02 Page 7 of 11 TEMP EVENT API’ 07/01/2024 The following is information about my organization/business: Name of organization/business: ‘ A Oirerj 7/5 Y / m c_ ____________________________ $0*1) Alternate: ( ) List food to be sold or given to the public: /Uftckg.} I am providing food that is NOT prepared at home: li^Yes O No /- All food is prepared on-site or is from approved commercial facilities: Yes No Name of facility: 7^ ;>Phone: Address offacllitv:/Z>// 5 'f'Ht _____________________________ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files, dust and the public)