Laserfiche WebLink
Environmental Health Department <br />Date(s): I.Name of Event: 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />1868 E. Hazelton Avenue | <br />F.HD 16-02 <br />07/01/2025 <br />SANJOAOUIN <br />------COUNTY— <br />Gijii’w jj/ovvs here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />.■e <br />(■GM <br />are those which sell beverages from <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 />The following is information about my organization/business: <br />Name of organization/business: /ri&nirvilvr} <br />I <br />List food to be sold or given to the public:. <br />Alternate: <br />4- Kt WtfWtMVS - /toolrfjd^ <br />Stockton California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 7 of 11 TEMP EVEN I APP <br /> On-site hose bib that is connected to a potable water source. <br />0 Other (specify): Z^f// ----------------------------------------—----------------------------------------------------- <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: 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 />0 Camp stove O Sterno & hotel trays <br /> Double steamer Steam table & lids <br />0 Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include; <br />ll/y <br />I am providing food that is NOT prepared at home: O Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: ®>Yes 0 No <br />Name of facility: TwrWAT&K X Phone: (^ ) ---------------- <br />Address of facility: ^6"^ 7^ C^1 -- <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 />ilo ^ot>TW <br />0 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 />5Z1 Other (specify): dllLl <br />Note: The only operations not required to provide enclosed booths <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: