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Environmental HeaSth Department <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />I <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 />z:” <br />8. <br />1868 E. Hazelton Avenue [ Stockion, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjgov.orq/ehd <br />EHD -!6-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 n <br /> <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />Date(s):. <br />The following is information about my organization/business: • ■ • • ' • • <br />Name of organization/business: l<l CCPS CbtJ,C! Q /D. <br />9^9 Mt. _____________ <br />^5$°l ) "^^3 S' Alternate: : <5^? ) 2-3^' <br />List food to be sold or given to the public: DiPPjtJ <br />I am providing food that is NOT prepared at home:^zYes No <br />All food is prepared on-site or is from approved commercial facilities: f^Yes No <br />Name of facility: rJ/A Phone: ( ) <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. &kI Cuo-SuSO <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 />I.Name of Event: _ Looi Stoer ftzie.5 <br />, SANJOAOUIN <br />'■ --------COUNTY <br />' YcrarY-’’ Greatness 9rows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> On-site hose bib that is connected to a potable water source. , <br />Other (specify): SbrCt fadmJ&D /"/xh/Z) (//fa// 3/a^^O______ <br />Electricityjs provided for my bootK’s use: Yes No f <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 operationYes No <br />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 />I am [ ........................ <br />ISST: r / <br /> Camp stove N /A <br /> Double steamer <br /> Electric stove top