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Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, oggs, and dairy products. <br />7. <br />8. <br />Other (specify). <br />The only operations not required to provide enclosed booths are those which sell beverages from <br />I rciJev <br />SAN JOAQUIN <br />COUNTY <br />(.i. (>!hi . ■. 'i Ik'i ■ . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />foods during all times of bootli operation:* <br />I am providing the following hot temperatur <br />135°F: <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Ollier (specify) <br />Note: Examples of potentially hazardous food include: <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wv/w.sjcehd com <br />EHD 16-02 PngeZotll 1EMPEVbNi Art <br />07/3/17 <br />I 1 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Nfother (specify): kd/S LAJlCed. <br />Electricity is provided for my booth's use: Myes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />................ .... .• MTlYesQNo <br />control for the hot holding of ali potentially hazardous foods above <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) weekspj ior to this event. ■ ■ I / I i <br />1. Name of Event: 4/)^ \ C 5 PVir V Date(s): l.o/ <br />The following is information about my organization/business: <br />Name of organization/business: —---------------------------------------- <br />Address: 3^ Celebm "Drive-z LoA\ (CA. ---------- <br /> <br />dC1]) 6^7, " H S — Alternate: ( ) <br />I ist fond to be sold or given to the public:s > kis <br />I am providing food that is NOT prepared at home: EJ Yes ^^No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: --------------------------- --------------------------------- -------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 flooi (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />pother (specify): Enrlosecl <br />Note: -...j _r------- <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: