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1 <br />( <br />[]No <br />\]^Other (specify); <br />iI <br />S~Z7 <br />SAN JOAQUIN COUNTlf <br />ENViQ^^'ENl’AL HEALTII DE'PA.IiTMENT <br />1868 Eiist Hazel toil Avenuej Stockton, California 95205 <br />BiisiHessi (20Q)46»-3420 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AU food vendors, {both for profit and non-profit) are' required to return a signed and completed copy of this <br />checklist to iho festival eoordmatvi three. $)’ weeks prior to this event <br />1. Name of Event! (.Y7^ Patefsjt <br />2. The following is information about my organizatioh/business: 1 IJCi'. If y <br /> <br />Name of orgamzation/busmess; f,rpb;^4ZW;Z/zP . .../. - z ------ ' Address: W £ |y <br />Phono: Aitornatb^f?'/6. ^'7' <br />3. List foocrto.be sold or given., to the publib: /P <br />X' --:-4., I aih prbvidiiig- food tiiat is^OT pfeparShome: [pTVcsZ [ ]Np <br />/\iifooaisp.reparedpp-$iie. oris from approved.commercial facilities;^ Yes _ Q Name of facility:. M ■ Bidne: <br />Address of facil2 .. <br />5. I am pfovidirig a booth with the foil owing: (to protect my unpackaged fodd and food-preparation arbas ftom <br />flies, .dtist-and thepupfic) <br />[ ] A booth with walls and ceiling constructed of either wood, canvas; plastic, similarmateri.al and fine <br />mesh fly screening, completely'enclosing.open food areas. It wlll also havd.g smooth'and c.leahable floor <br />(concrete, asphalt; clean tarps and smooth-wood arc acceptable) arid constructed to separate food arid food <br />Note: Tie only^Sfions nOquired to provide enclosed booths are tltose which sW beltofhgesfrom <br />approved dispensers, or prepackaged foods from approved sources,’ <br />6. Approved water for drinking, utensil and hand washing vzill be provided in my booth by the following <br />methods: <br />[ j Approved bottled water/ <br />7. Electricity is provided tor my bobth’s use; [ ] Yes $4 Nd v J <br />8. I am providing an .accurate probe thermometer to measure the hot and cold holing oTpotenUall^ hazardous^ <br />foods during all time of booth operation:- £/| Yes [ ] No r <br />9. I am providing the following hot temperature control for the-hot holding of all potentially hazardous foods <br />above 135 degrees Fahrenheit: • <br />[ ]. Camp Stove [] Double steamer [ ] Electric stove top.- ./M IJa I <br />( ] Sterho. & hotel frays [ ] Steam table &, lids [/zf Other (specify); <br />Note: Examples of potentially hazardous food include: meat’s, tamales, cooked beans, rice vegetables, <br />potato salad, eggs-and dairy products.