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Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />7/24-7/25/2026I.Name of Event:1.Date(s): <br />2. <br />Address: <br />483-7323 450-9795Phone:) <br />3.List food to be sold or given to the public: <br />4. <br />) <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[x] Approved bottled water. <br /> Alternate: (209 ) <br />Tri-Tip, Hot Dogs, Chips, Soda, Water <br />The following is information about my organization/business: <br />Name of organization/business: hscalon Youth Cougars <br />PO Box 326, Escalon, CA 95320 <br />SAN JOAQUIN <br />iWh..': Y ----COUNTY----- <br />G’rcolim-ss grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />0 On-site hose bib that is connected to a potable water source. <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />the festival coordinator three (3) weeks prior to this event. <br />Park Fete <br />( 209 <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes [*) 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: H Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />EJ Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sicehd.com <br />EHD 16-02 Psge? of 11 TEMP EVENT APP <br />07/3/17 <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 />I am providing food that is NOT prepared at home: Q Yes No <br />All food is prepared on-site or is from approved commercial facilities: [x] Yes No <br />K..... @ Park Fete - Escalon, CAName 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)