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Environmental Health Department <br />I.Name of Event:1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br />135-F: <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br />CO&IfZ <br />meats, tamales, cooked beans, rice, <br />5 / <br />measure the hot and cold holding of potentially hazardous <br />E/No <br />ilfor the hot holding of all potentially hazardous foods above <br />Name of organlzation/buslness: __ <br />Alternate: ( <br />List food to be sold or given to the public:. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pago 7 of 11 TEMP EVENT <br />07/3/17 <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />' i -I- ; <br />U/FOV'' <br />VSANJOAQUIN <br />-) ------COUNTY------- <br />Grculness yrotvs lit’ie. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify): <br />Electricity Is provided for my booth's use: Yes [JfNo <br />I am providing an accurate probe thermometer to <br />foods during all limes of booth operation: Yes I <br />I am providing the following hot temperature controltor the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br />[Q*6ther (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 />Date(s): <br />The following is information about my organization/business: <br />I am providing food that is NOT prepared at home: 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 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 />Q Other (specify): VJI A' <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 following methods: