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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Daie,siMay4-5,2024i1 Name of Event <br />2 <br />Address <br />Alternate (Phone ()) <br />3 List food to be sold or given to the public <br />4 <br />5 <br />Self contained Food trailerOther (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />D Approved bottled water <br />9 <br />meats, tamales, cooked beans, rice, <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 />Sontrol for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />O A booth with walls and ceiling constructed of either wood, canvas plastic, similar matenal 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 />Note Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> On-site hose bib that is connected to a potable water source <br />other (specify)Self contained Food trailer <br />Electricity is provided for my booth s use {Q.Yes D No <br />I am providing an accurate probe thermWieter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation (T^k’S C No <br />I am providing the following hot temperatun <br />135”F <br /> Camp stove <br />O Double steamer <br />O Electric stove top <br />I Concillo cinco de mayo------ <br />The following is information about my organization/busmess <br />Name of organization/busmess CrepeTea___________ <br />P.O. Box 692012 stockton ca 95269 <br />(209)871-6476 <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | www sjgov org/ehd <br />EH0 '«-02 r or 11 TEMP EVENT APP <br />l»2*20ZJ <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 facilitieyC Yes O No <br />Name of facility California food truck wasn. phone(2Q9)) 464-9707 <br />Address of facility 730 CalifQrnia st. Stockton ca 95206 <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)