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4/16/26, 3:00 PM profi!e7.cfm (3024x4032) <br />Environmental Health Department <br />i. <br />1. <br />2. <br />Phone; <br />3. <br />4. <br />5. <br />10 y 1 D <br />those which sell beverages from <br />6. <br />9. <br />above <br />meats, tamales, cooked beans, rice, <br />1/1https://convenlionforce.cotri/e/proflle7.cfm?downloadpld--2G50358&inbrowsor=1 <br />I www.sjgov.org/ehd <br />TEMP EVENT APP <br />7. <br />a; <br /> Alternate: ( <br />1 ) LC.A , <br />Yes No <br />)__-------------------------------- <br />S by (a tnoj-6icG.? <br />■>868 E. <br />EHD 16-02 <br />All food vendors (both for profit and non-profit) are required to return <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: loth Sfaif -Wi% <br />SAN JOAQUIN <br />------COUNTY <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br /> Date(s): !__ <br />(2cLThe following is Information about my organlzatlon/buslness: t , <br />Name of organization/buslness: S I <br />Address: 0 A q,1? r3^-_U. <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:^ '1 c» 11 tvu - <br />All food is prepared pn-site or is from approved commercial facilities: S Yes O No <br />Name of facility; -Ao1 0. t’ 0ItA Phone: <br />Address of facility; . It lpD I P-l vLO/fc>Cikvk- (?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 />'iSOther (specify): IQyiD <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved wafer f^r 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 /> Other (specify):_________________ <br />Electricity Is provided for my booth's use: Yes S No ~ — <br />' sziin«xu ;TLS0ePe;:;'ono□lfeou^cx,o, and cold holdln9 of hazardous <br />1 ™ P£'',dl"9,he fotan9 hot temperature control for the hot holding of all potentially hazardous foods <br /> Camp stove Q Sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top '^Other (specify) <br />Note: Examples of potentially hazardous food Include' <br />vegetables, potato salad, eggs, and dairy products. <br />Hazelton Avenue | Stockton, California 96205^ TM9 468-3420 | F 209 464-0138