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Environmental Health Department <br />05/07/2023Date(s):1. <br />2. <br />Address: <br />) 209-553-0417209-400-3664 Alternate: ( <br />3. <br />4. <br />5. <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APP <br />7. <br />8. <br />Name of organization/business: <br />2579 Waterloo Rd., Stockton, CA 95205 <br />The following is information about my organization/business: <br />Michelada Mix El Cejas <br />SANJOAOUIN <br />-----COUNTY----- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />1. Name of Event: Cinco de Mayo Family Festival <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD16^2 Page 7 of 11 TEMP EVENT AJ <br />06/19/19 <br />Phone: ( ) <br />List food to be sold or given to the public: Preparing drinks & selling packaged qummies--------------- <br />I am providing food that is NOT prepared at home: H^Yes O No <br />All food is prepared on-site or is from approved commercial facilities: EfYes 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 />BTa 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 />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 />SZ^Approved bottled water. <br /> Other (specify):-------------------------------------------------------------------------------------------------------------------- <br />Electricity is provided for my booth’s use: Q Yes [V 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: CH Yes |M No Not selling food <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />ISS’F. <br />[3 Camp stove EZI Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify)