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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1. <br />2. <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />209 922 3782 <br />5. <br /> 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[^Approved bottled water. <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 /> Sterno & hotel trays <br />Steam table & lids <br /> Other (specify) <br />) <br />Cottoncandy Birria <br />__________ Alternate: ( <br />Aguas frescas <br />Name of organization/business: <br />1080 west F St <br />SAN JOAQUIN <br />COUNTY- <br />The following is information about my organization/business: <br />Fancy’s Cafe________ <br />Oakdale ca 95361 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth’s use: <br />I am providing an accurate probe thermor <br />foods during all times of booth operation: <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />' — . TtT»«n EA/CMT AtEHD 16-02 Page 7 of 11 <br />06/19/19 <br /> Yes No <br />imeter to measure the hot and cold holding of potentially hazardous <br />i:J\]YesE]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 <br /> Double steamer <br /> Electric stove top <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 />May 4-5 2024Cmco de mayo Date(s): <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: 0- Yes No <br />Name of facility: Fancy’s Cafe_______________ Phone: (1 <br />Address of facility: 1080 West F st suite C Oakdale <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 />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 />Address: <br />( 209 922 3782