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Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1.I.Name of Event: <br />2. <br />Address: <br />333-9369Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />8. <br />9. <br />meats, tamales, cooked beans, rice. <br />SAN,J0A0UIN <br />----COUNTY----- <br />Greotness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />The following is information about my organization/business: <br />Name of organization/business: Lane s Soulful Expressions <br />7188 E FOUNTAIN WAY, FRESNO, CA 93737 <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />the festival coordinator three (3) weeks prior to this event. <br />Stockton Waterfront Smooth Jazz Festival <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www.sigov.org/ehd <br />Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />I am providing food that is NOT prepared at home: S/Yes No <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 />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 />S^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 />(559 ) 918-0969 Alternate: (510 ) <br />List food to be sold or given to the public: Fried Fish, Fried Fish Tacos, Fried Ribs, Fries, Greens & Potato Salad <br />Approved water for 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 />pother (specify): 25 galiOn 'a100 <br />Electricity is provided for my booth's use: fc/f Yes Fl 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: 0 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 0 Stemo & hotel trays <br /> Double steamer Steam table & lids <br />O Electric stove top | | Other (specify) <br />Date(s): 6/20 & 6/21/2026