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TEMPORARY EVENT APPLICATION - SJC-HealthDept-3.pdf <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />7 of II <br /> 5/6/2026, 12:55 PM <br />9. <br />SAN JOAOUIN <br />COUN’V <br />fi le:///C :/Users/Joe/Down loads/SJC-HealthDept-3 .pdf <br />Hazelton Avenue I Stockton. California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />07/01 /2024 Page 7 of 11 TEMP EVENT APP <br />are those which sell beverages from <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />nc«ArHino!h and are required to return a signed and completed copy of this checklist to <br />1-Name of Event; C Date(s): 7/^ <br />The following is information about my organization/buslness <br />Name of organization/business: <br />d?o\.o Lo-vx-e <br /> Alternate: ( )_ <br />List food to be sold or given to the public:<±.OY\ELS> <br />I am providing food that is NOT prepared at home^ Yes No t’Kc. ^4 y 40 <br />All food is prepared on-site or Is from approved commercial facilities. Yes No <br />Name of facility: —___________________________________phone; ( )___________________ __ <br />Address of facility:______________ <br />' T Pr°V±9 3 buO.Oth the followin9: <t0 Protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />raXbooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />keening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />areasafromethetpubhcand Sm°Oth WOOd are accePtable) and constructed to separate food and food preparation <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths <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 />J^rtpproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): k <br />Electricity is provided for my booth’s use: Yes ~ <br />1 ^^aCCUraJ^ PTObe therrnom®ter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />' the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove stemo & hotel trays <br /> Double steamer 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.