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Environmental HeaUth Department <br />1.I.Name of Event: <br />2. <br />c-Lne -t <br />3.-b <br />4. <br />5. <br />)<yv4~V) Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />O Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 [ www.sjcehd.com <br />EHD1S-02 Page 7 of 11 TEMP EVENT APP <br />□7/3/17 <br /> <br />7. <br />8. <br />SANJOAQUIN <br />.-------COUNTY------- <br />Grcul/it’ss yraivs hun. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Al! food vendors (both for profit and non-profit) are recuired to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />LpAl <^0^4 <br /> Sterno & hotel trays <br /> Steam table & lids <br />r pother (speciiy) ‘ (I ^7 <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. <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 /> On-site hose bib that is connected to a potable water source. <br />®)ther (specify): A A- ____________________ <br />Electricity, is provided for my booth's use: Yesj&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 /> Camp stove <br /> Double steamer <br /> Electric stove top <br />... SUW , <br />I <br />-d Sxo <br />Date(s):. <br />IO y to <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: i5y~? o ____ ___ <br />Phone: (9^. ) Alternate: ( ) <br />List food to be sold or given to the publlc:F/C>Q <br />1 am providing food that is NOT prepared at home: Yes'S No <br />All food is prepared on-site or is from approved commercial facilities: O Yes jYI No <br />Name of facility:Phone: ( ) <br />Address of facility: <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)