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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event: Valerie Frazier Date(s): 07/18/2026. <br />2.The following is information about my organization/business: <br />Phone:(209) 507-9588 <br />3. <br />4 <br />5 <br /> Other (specify): <br />6.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 />9 <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Other (specify): <br />Electricity is provided for my booth’s use. 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <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 />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www sjgov org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />inAAr <br />Alternate: (916) 690-3420^ <br />List food to be sold or given to the public: Hot Dogs, Tacos, Chips, Drinks Qsq TS <br />SAN JOAO <br />COUNT <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Yes 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 EH Sterno & hotel trays <br /> Double steamer Steam table & lids <br />GH Electric stove top Other (specify) <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 />I am providing food that is NOT prepared at home: IS Yes No <br />All food is prepared on-site or is from approved commercial facilities: H Yes No <br />Name of facility: AgL Phone: ( <br />Address of facility: / Qp C? Kl CA TSJfly <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 />H 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 />Name of organization/business: Helping Out People Everyday (H O P E.) Ministries <br />Address: 4212 N. Pershing Avenue, Suite A5, Stockton, CA 95207