Laserfiche WebLink
Environmental! Health Department <br />the festival coordinator three (3) weeks prior to this event <br />1.I.Name of Event <br />2. <br />Name of organization/buslness: <br />4623 Chelsea Drive Oakley, Ca. 94561Address: <br />Phone:( 925 ) 584-1916 ) <br />Salsas, DipsList food to be sold or given to the public:3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that Is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 461-0138 | www.sjgov.org/ehd <br />Page 7 of 11 TEMP EVENT AtTEMP EVENT APP06/19/19 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />O Approved bottled water. <br />Alternate: ( <br />(pre-packed) <br />7. <br />8. <br />I am | ............... <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Q Other (specify):________ <br />Sechiciiy is provided for my boottfs use: Id Yes! I No — <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <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 following is information about my organization/buslness: <br />Norma's Wicked Salsas <br />SAN JOAQUIN <br />------COUNTY------- <br />Grsotne^r, qrov.r. Itctu. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation: Yes 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 />[3 Other (specify) Electric coolers <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 /> A booth with walls and celling 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 />I am providing food that is NOT prepared at home: S Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes Q No <br />Name of facility: t 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)