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SAN JOAQUIN hnviroriirierrtal I lealth DcpariiHeiii <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone <br />3 <br />4 <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6. <br />9 <br />meats, tamales, cooked beans, rice, <br />7. <br />8 <br />Datc(s). <br />Approved bottled water. <br />LJ On-site hose bib that is connected to a potable water source. <br />F I Sterno & hotel trays <br />I | Steam table & lids <br />Other (specify) <br />Noto: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <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 arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />yj Other (specify) lS> <br />Noto: 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 />[ J Other (specify):_____________ ____ ______ _______ ___________________________________________ <br />Electricity is provided for my booth's use: |_] YesJ>d No <br />I am providing an accurate probe thermometer'lo measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: | ] Yes^ No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />[ | Camp stove <br />! | Double steamer <br />1.1 Electric stove top <br />IBG8I I lazellon Avenue I .Stockton California 9S2()!> | T ',’09 4G8 3-120 | I ■ -I'M i' I .'»:i ■ www sjgov •'ic enii <br />I l II) •.6 02 f’ngc Z of 11 Ti;MP I V! MI A0P <br />07/01/2024 <br />All food vendors (both for piofil and non-profit) arc 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: <br />The following is information about my orgamzation/business: . <br />Name of organization/buslness:. <br />Addross: <br />Alternate (^ ) <br />List food to be sold or given to the public:. . ----------------------------- <br />I am providing food that is NOT prepared at homo.^O Yes No <br />All food is prepared on-site or is from approved commercial facilities: M Yes [. J No <br />Name of facility woe fojmn _ Phono: <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)