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Date(s): Zrf-d/,, ‘262 51. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />r <br />5. <br />6. <br />£X)n-site hose bib that is connected to a potable water source. <br />the hot and cold holding of potentially hazardous <br />9. <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <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 />1. Name of Event: A//Q /7 / Kfc ~~T <br />SANJOAOUIN <br />------COUNTY------ <br />GreoJnrss (jrows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sigov^g/ehd^ <br />EHD 16-02 Page 7 of 11 <br />nK/oa/onoi <br /> 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[^Approved bottled water. <br />'ll <br />Environmental Health Department <br /> Other (specify):----- ----------- <br />Electricity is provided for my booth’s use: M Yes U No <br />I am providing an accurate probev thermometer to measure <br />foods during all times of booth operation: [SZes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Camp stove O Stemo & hotel trays <br /> Double steamer Steam table & lids <br />(p^lectric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include:meats, tamales, cooked beans, rice, <br />The following is information about my organization/business: <br />Name of organization/business:A*/? A/I'V/ <br />1133^ ______ <br /> (2^ ) 8757 Alternate: ( g/^^) 3^ - S ------ <br /> <br />List food to be sold or given to the public: f 'pbfk ------ <br />I am providing food that is NOT prepared at home: EEfYes O No <br />All food is prepared on-site or is from approved commercial facilities. [Q^es No <br />Name of facility: i ■ P^one: .^3- <br />Address of facility: /V• “AtZ?z ^^7------------— <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 />[^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.