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Environmental Health Department <br />v>i1.1 .Name of Event: <br />2. <br />Address: <br />Phono: <br />3. <br />4. <br />) <br />5. <br />[ | Other (specify): <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods:6. <br />(J Approved bottled waler. <br />9. <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <br />[J A booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. Il 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 />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 />1868 E. I lazolton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ohd <br />I III) Ki 02 Page / of 11 TFMP EVENT API’ <br />06/29/2023 <br />------COUNTY------ <br />Greotncss grov/s here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />["] Sterne & hotel trays <br />Steam table & lids <br />[ J Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />L| On-site hose bit) that is connected to a potable water source. <br />Other (specify): 7^ <br />Electricity is provided for my booth's use: ["] Yes LI 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: W Yes [ J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <br />| ] Camp stove <br />( J Double steamer <br />LJ Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: <br /> Alternate: <br />List food to bo sold or given to the public: <br />I am providing food that is NOT prepared at homey^d"Yes Cl No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes [J No <br />Name of facility: Phone: f <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 />/ „ SANJOAQUIN <br />-