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Environmental Health Department <br /> <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />9. <br />Hisi <br />1 k: <br />the festival coordinator three (3) weeks prior to this event <br />1. <br />•i J <br />I <br />w <br />it <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />/() /b Y <br />III <br />11i <br />I <br />1 <br />j <br />SAN j DAO UIN <br />TO U N TY <br />.91^ •> g s her . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />eh di 5-02 Page? of 11 ’ “i.r.z.z;;?;..’ <br />07/3/17 <br />7'7^7^ <br />The following is information about my organization/business: <br />Name of orqanizationA)usiness:^7^/_^<g7g^73~j5L^^:C^- <br /> Alternate^ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:^6r es D No <br />All food is prepared on-site oris from approved confrnercial faciliiies>£LYes D No <br />Name offacility:^€rZ7^<^Xr-.- - - Phone:., 7'?? T <br />Address offacilijy:_^o7 L7jfz^ <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 />D 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 />er (spediyj: JO (J(J_ <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 />D Approved bottled water. <br />D On-site hose bib that is connected to a potable water source, ' a <br /> <br />Electricity is provided for my booth’s use: D Yes D 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: D YesD No <br />1 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />D Camp stove •. /Stemo & hotel trays <br />D Double steamer r ’ D Steam table & lids <br />D Electric stove top D other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1. Name of Event: J-J^)j) / <br />1 i