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SAN JOAQUIN Environmental Health Department <br />Oatc(s): <br />2. <br />Phone: <br />3. <br />4 <br />5 <br />6. <br />9 <br />meats,tamales, cooked beans, rice, <br />7. <br />8 <br />I www.sjgov oiq.ohd <br />ICMP EVENTAPP <br />potentially hazardous foods above <br />X07 <br />and cold holding of potentially hazardous <br />S'te',n"AW'n'Q| SlOCk,O'’ Ca,ito'n'a9=^p5 I ^209 468-34201 F 20 9 464-0133 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and no <br />the festival coordinator three (3) weeks pho?to this evenl^ 3 S'9nCd and comple,ed copy of this checW,s‘to <br />1- 1. Name of Event;/J/J/ <br />The following is information about <br />Name of organization/business: <br />Address: <br />( ) <br />list food to be sold or <br />my organization/business. <br />Alternate: ( ) <br />given to the public: ^;iZ/7y <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 O 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 />[J 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 />Other (specify): <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: <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth's useHj Yes No ------------------------------------------------------ <br />' THnd^H16'119 a," accurate Probe thermometer to measure the hot and cold h< ‘" <br />foods during all times of booth operation: O Yes O No // / < <br />I am Providing the following hot temperature control for the hot holding of <br /> Camp stove Sterno & hotel trays <br /> Double steamer Q S(eam |ab|e & |jds <br /> Electric stove top Other (specify) <br />No,e: vnn»taPMS °f potGn,la'|y hazardous food include- <br />vegetables, potato salad, eggs, and dairy products '