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Environmental Health Department <br />1.1. Name of Event: St. Bernards Fall Festival September Sth & 9th 2023 <br />The following is information about my organization/business: <br />Name of organization/business: St. Bernards Church <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY------ <br />Grtotncis growi here, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />L8n Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 I www.sjgov.org/ehd <br />S.™23 P^7OM1 TEMPEVENTAPP <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):_______________ <br />Electricity is provided for my booth’s useife Yes No “ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation-^ Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Sterno & hotel trays <br />^QjDouble steamer Steam table & lids <br /> Electric stove top ® Other (specify) 0 C. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />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 />(209) 835-455Q Alternate: ( 209 )607-7308 <br />List food to be sold or given to the public: S <br />I am providing food that is NOT prepared at home: [X] YesQ No <br />All food is prepared onsite or is from approved commercial facilities^ Yes® No <br />Name of facility: Phone: ft##)) <br />Address of facility: CO - Qx-feo/^ fiUS [COCf/ <br />I am providing a booth with the following: (to protect my unpackagedfcodl and food-preparation areas from flies <br />dust and the public) <br />-SfyA 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 /> Other (specify): <br />Address: 163 W. Eaton Ave, Tracy, Ca 95376