COMPLIANCE INFO_2025 - Laserfiche WebLink

Home Browse Search

-, SQ N;� Q�Q Q N Environmental Health Department iL C �_, - —COUiVTY— °��rFo1S�'F'. Greatness 1ror.s here. TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit)are required to return a signed and completed copy of th checklist to the festival coordinator three(3)weeks prior to this event. 5/6 * 01:�, Z05 1. 1.Name of Event: S"1 I e&+ F4 r �' ��/ �J� lZr W,,,ate(s): I51 1 S -(8 jZ D 2. The following is information about my organ lzationlbusinesl-s: Name of organizationlbusiness; �(� C� C 2 Address: AX5I (*6o TsY& �� CAI `JJ Phone: - M) 51 u 5 ne l Alternate: 3. List food to be sold or given to the public: a Ke-d C10 04-5 4. 1 am providing food that is NOT prepared at home:XYes❑No All food is prepared on- or is from proved commercial fact'ties: Yes El No Name of facility: 65a, or�'L (�25,5 i l ( �►Qa - 5 S5-�q Ipl Address of facility: 9blZI _r&C1KS6rf 5. 1 am providing a booth with the followinng:-(to protect my unpackaged food and food-preparation areas from flies, dust and the public) k"A booth with walls and ceiling constructed of either wood,canvas, plastic,similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and food preparatioh areas from the public. ❑Other.(speclfy); Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. -. - 6. Approved water for.drinking,utensil.and hand washing will be provided.in ray.booth by the following methods:... ❑Approved bottled water. ❑On-site hose:bib that is connected to a potable water source. ❑Other(specify): 7. Electricity is provided for my booth's use?-❑Yes —o --- - 8. 1 am providing an accurate probe thermarb0er to rieasure the hot and cold holding of potentially hazardous foods duripg all times_Rf boath operation-.❑Yes.D No 9. 1 am Providing the fb_116 ing hot temp tune conuol fpr the-hot fiolding a#all=potentiaffy hazardo>s f6bds ve "`� 135'1=: ❑Camp stove ❑Sterno&hotel trays ❑Double steamer ❑Stearn table&lids ❑Electric stovetop ❑Other(specify) Note: Examples of potentially hazardous food 1rididde: Meats, tamales, caaked beariq, rice, vegetables,potato salad,eggs,and dairy products. 1868 E..Hazelton Avenue I Stockton,California 95265 I T 209 468-34261 F 269 464-0138 1 www.sjcehd.com END 115,02 page?of 11 fEmp EVEN7 AFF 07)3117