Laserfiche WebLink
Environmental HeaDth Department <br />1. <br />2; <br />) — <br />3. <br />4. <br />5. <br />( <br />6. <br />9. <br />i <br />7. <br />8. <br />AH food vendors (both for profit arid 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 /> Date(s):- <br />f 10 <br />//_____________ <br />___________ <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209464-0138 ( www.sjcehd.com <br />EHD 16-02 Pase 7 of 11 TEMP EVENT APP <br />P7/3Z17. <br /> <br />SANTAQUIN <br />h Ol fefe ----COUNT Y---- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: , 'i 6 A f <br />Address: 33^ L-at/i Loji s',A, <br />■Phone: • ) S !CD & &Alternate^ ; <br />List food to be sold or given to the public: CD J <br />1 am providing food that is NOT prepared at home:JT] Yes No <br />All food is prepared on-site or is from approved commercial facilities: S Yes No <br />Name of facility: C/t )C I J, Phone: (€<??) <br />Addfe'ss of facility: AY L/& (a)' /C *7.^------------------- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />deist and the public) <br />£3 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 ffoni the public. <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 foiidwihg methods: <br />pc] Approved bottled water. <br /> On-site hose bib that is connected to a potable.wafer source. <br /> Other (specify):._______----------------------------------------------------------------------------------- <br />Electricity is provided for my booth’s use: LJYesJz] 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: 0 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 /> Ggrrip stove Sterno & hotel trays <br /> Double steamer Sfeafri table & lids <br /> Electric stove top -ETOTier (specify) O <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, arid dairy products.