Laserfiche WebLink
Environmental Health Department <br />1. <br />z <br />Address; <br />Alternate: ( <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br /> rsna <br />7. <br />8. <br />) <br />,FO . <br />SANJOAQUIN <br />r •------COUNTY------- <br />C«i rnrih'si /j/ox-.s <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />1863 E. Hazelton Avenue) Stockton, California 952051 T 209 463-3420) F 209 464-0138 | www.sjcehd.com <br />EJ10 1M2 Pcge7o<H TEM? EVENT APP <br />07/VI 7 <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):bJ n _________________________________________________________ <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 />food£ 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 /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <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: - DateCs):^ ] 5/^ k <br />The folio-wing is information about my organization/business: <br />Name of organization/business: AtOOk ■.----------------------- <br /> ------------------ <br />Phone: ((fT) o <br />List food to be sold or given to the public: OifflfiOTACl <br />I am providing food that is NOT prepared at home: YesNo <br />All food is prepared on-site or is from approved commercial facilities: O Yes No <br /> Name of facility: CffvA-pU Phone:(^)^Cr-'5b7o <br />Address of facility: — <br />I am providing a booth with the following: (to protect rnyjinpackaged 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.