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¥ * <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />08 (ic/io L V1.Date(s): <br />2. <br />TwJfaA fubSjrC <br />B OddAddress- <br />Phone: <br />SnaCKS3. <br />7 <br />4 <br />5. <br />[3 Other (specify) <br />6. <br />O On-site hose bib that is connected to a potable water source <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the foliowing methods: <br /> Approved bottled water <br />LJ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing o[>en 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 />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approvea dispensers, or prepackaged foods from approved sources. <br /> Other (specify). | <br />Electricity is provided for my booth's use: O Yes Ls^No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />) <br />SAN JOAQUIN <br />CO'J N”Y <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are i ‘ ‘ <br />the festival coordinator three (3) weeks prior to this event <br />I.Name of Event: J 0 j_ A J D/E P£ Ai OCA) |3 OZ) V <br />1868 E. Hazeiton Avenue | Stockton California 95205 J T 209 468 3420 | F 209 464-0138 I www sjgov org/ehd <br />E HD 16 02 o’11 ' " “ <br />06,?^702T <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: x <br /> Camp stove ETStemo & hotel trays <br />LJ Double steamer Q Steam table & t:ds <br /> Electric stove top Other (specify) <br />Alternate: ( <br />Tiie following is information about my organization/business <br />Name oforganization/business: | J| ki It Kffi <br />2 SO l, aJ TYaCj fihlJ ) <br /> ) 6^7 <br />List food to be sold or given to the public V C j <br />I am providing food that is NOT prepared at home. EfYes No <br />All food is prepared on-site or is from approved commercial facilities. R^Yes No <br />Name of facility: HI kH 1 rd H (u, i $ tC Phone: 7 00 <br />Address of facility 9 -t pIvlA TYC\C A ___ <br />i am providing a booth with (he following: (U protect my unpackt^ed food and food-preparation areas from flies, <br />dust and the public)