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<br />Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />a smooth and cleanable floor (concrete, <br />to separate food and food preparation <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sigov.org/ehd <br />EHD 16-02 Pa9e 1 01 11 TEMP EVENT APP <br />06/29/2023 <br />SAN JOAQUIN <br />------COUNTY------- <br />Grratn.-’.-' <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three (3) weeks prior to this <br />I .Name of Event: <br />Q A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />-screening, completely enclosing open food areas. It will also have r--------* y <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to <br />areas from the public. <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 />I am providing food that is NOT prepared at home: FQ Yes Q No <br />All food is prepared on-site or is from approved commercial facilities: CFI Yes Q No <br />Name of facility:LLI&______________________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 />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />; event. <br />Date(s): <br />The following is information about my organization/business: <br />Name of organizattoiVbu^ness: ______ <br />Phone: (/£?ty ) | f Alternate: l -- <br />List food to be sold or given to the public: QfkMflS <br /> Other (specify):_ __________________________ <br />Electricity is provided for my booth’s use: Yes No ' <br />I am providing an accurate probe thermortteffer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ffl^Yes No <br />I am providing the following hot temperaturfecontrol for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer . Steam table & lids , <br /> Electric stove top t^dther (specify) QUK/V- M-l (' V hX ’ <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 beveraoes from <br />approved dispensers, or prepackaged foods from approved sources. y