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SAN JOAQUIN <br /> <br />Environmental Health Department <br /> <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for profit and non -prrifrt) am rem rirect to return A signori And r:nrnpfPfed copy of this checklist to the festival reordlnatot three (3) weeks prior to tfs event <br />1 Name of Event: 13 f efArmrP..t.t Date(9)7 <br />The tot4owfrtg IS Information about my orcianizationibusiness <br /> <br />Name of organi7ationfbusiness: <br /> <br />A4,-.424e1 .2 Address: 14cc A4444 Stkliacja '1 /4=) Ct.N j. <br />Phone: 49 4. 3 k 41, Alternate: tat 9) c-/ er<L. I '-j, "Y - <br />List food to be sold or oiven to the public: it; it. <br />4 I am providing food that is NOT prepared at home: Pf Yes [I] No <br />All toocl is prepared on-site or is from approved commercial facilities: [El Yes Ej No <br />Name ot facility. „II c-'.. -A, ‘ <br />itr. RP i----r, lit— f-,4 ii.e...-14 a Phone: (791 1../ <br />Address of fal <br /> <br />.T.:s2a "4 '\._-_,.4....KIL,,,,2, r...,-42.21 . ,, • I am providing a booth with the3ollowing: (to protect unpackaged food and food-preparation areas from lies, <br />dust and the public) <br />n A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and line mesh <br />screening, cam. pletely enclosing open food areas. it will also have a smooth and clearable floor (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and feed preparaticr <br />areas from the public. <br />Ei Other (specify): <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 />6 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Q-Approved bottled water. <br />Ea On-site hose bib that is connected to a potable water source. <br />EJ Other (specify): <br />7 Electricity is provided for my booth's use: t Yes Li No <br />8 I am providing an accurate probe thermorrer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: M-Yes Li No <br />9. 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 />Ej Double steamer <br />Li Electric stove top <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-34120 I F 209 464-0138 j www.sjcehd.com <br />END 16-02 Pagd 1 of 11 TEMP EVENT APP <br />CZStemo & hotel trays <br />D Steam table & lids <br />ba Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.