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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />TEMP EVENT APPPage 7 oJII <br />7. <br />8. <br />“J' <br />meats, tamales, cooked beans, rice, <br />SANJOAOUIN <br />- COUNTY-- <br />i. . .. . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify):________________________________________________________ <br />Electricity is provided for my booth's iise: Yes O 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 />[J Camp stove Slerno & hotel trays <br /> Double steamer SJjsam table & lids <br /> Electric stove top QBther (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />O 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. p’VC <br /> On-site hose bib that is connected to a potable water source. <br />Date(s): PQnufijVVr Gyv( <br />1868 E. Hazelton Avenue J Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />£11016-02 Page? of 11 TEMP EVENT <br />07/3/17 <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 />I.Name of Event: <br />The following is infonnatlon about my organization/business: <br />:\3r<anS XYcWn <br />T <br />Name of organization/business: ............. <br />Address: CoUme Pule. Cft. <br />(_____________ Alternate: ( ) <br />List food to be sold or given to the public: peon i-VW \HV <br />I am providing food that is NOT prepared at home: □ Yes QYTo ' <br />All food is prepared pn-site or is from approved commercial facilities: Yes LTNo <br />Name of facility: QFO & ZJ \Phone: ( <br />Address of facility: _________________________________________________________________ <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />0^ 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 cleanabie floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.