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Environmental Health Department <br />I.Name of Event:1. <br />2. <br />SHIAAddress: <br />3. <br />4. <br />5. <br />O Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <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 />er to measure the hot and cold holding of potentially hazardous <br />Yes No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[^Approved bottled water. <br />) <br />Art Wp <br />Date(s): s/y/ty-z/rAy <br />SAN JOAQUIN <br />COUNTY-— <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />• min m/riiT *iEHO 16-02 Page7o(11 --------■- <br />06/29/2023 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />O Other (specify): <br />Electricity is provided for my booth’s use: Yes S No <br />I am providing an accurate probe thermomel <br />foods during all times of booth operation: 0 <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 PCstemo & hotel trays <br />O Double steamer Q Steam table & lids <br /> Electric stove top Other (specify) <br />KL 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 />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 />C; n co o____________ <br />The following is information about my organization/business: <br />Name of organization/business: /ArbMvtu <br />/t>/ AJ SboIcVovy, 0/^ <br />Phone: (^5^0 - Alternate: ( <br />List food to be sold or given to the public:T/r IC<^ <br />I am providing food that is NOT prepared at home: 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)