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Environmental Health Department <br />1.Date(s): <br />2. <br />l/\d! . C.n ^^2- <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />7. <br />8. <br />Alternate: ( <br />The following is information about my organization/business: <br />)_______________________ <br />SANJOAOUIN <br />—county— <br />Greatness.growi; I'lere. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />□ Yes [J4M0 <br />_ Phone: (70^ Cg <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: L fy~A \ / -P j), V~ <br />O On-site hose bib that is connected to a potable water source. <br /> Other (specify):_ <br />Electricity is provided for my booth’s use: Yes 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 />* aJsST Vid'n9 the f°ll0Win9 hot temPerature control for the hot holding of all potentially hazardous foods above <br />O Camp stove Q Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />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 I wvav siqov orq/ehd <br />P8Se7°"1 TEMPEVENTAPP <br />' J "T : <br />Name of organization/business: <br />Address: <br />(____________ <br />List food to be sold or givenJ^.the public: TQ/A.f ; <br />I am providing food that is NOT prepared at home: Yes [Zi^o <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: | <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) <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 />El Other (specify): Rjod <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.