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R EC-008 <br /> <br />SAN JOAQUIN E:nvkonmenta Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <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 /> <br />Music in the 9-21-24 <br />1_Name of Event: Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: Stp_e_e2 <br />Address: CheCtqr_.th. <br />Phone: (:) gi <br />List food to be sold or given to the public: I, erY\ Cy'a <br />I am providing food 1hat is NOT prepared at home_ es <br />All food is prepared on-site or is from approved commercial facilities:7Ye <br />Name of facility: Phone: <br />Address of facility: <br />1 arn providing a booth with The following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />sc eening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concre1e, <br />asphalt, clean tarps and smooth wood are accep1able) and constructed to separate food and food preparation <br />areas from the public. <br />1-1)ther (specify): <br />Note: The only operations no1 required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />nApprovecl bottled water. <br />"n-site hose bib that is connected to a potable water source. <br />Pther (specify): <br />7 ecrictly is provided for my booth's use <br />B. I am providing an accurate probe therrrt <br />foods during all limes of booth operation <br />9. I am providing the following hot temperatu <br /> <br />Ye INo <br />rrair-rdnasure the hot and cold holding of potentially hazardous <br />Yes -‹ o <br />W-c-ontroi tor the hot holding of all potentially hazardous foods above <br /> <br />1 <br />l <br />5°F: <br />amp stove <br />uble steamer <br />lectric stove top <br /> <br />Stemo & hotel trays <br />Steam table & lids <br />Other (specify) <br /> <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazeiton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sigov.orgiehd <br />EHD 1 6-02 Page 7 of 11 TEMP EVENT APP <br />06/19119 <br />Alternate: