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Environmental Health Department <br />MDate(s):1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />IJ Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br />SAN JOAQUIN <br />COUNTY— <br />"i f/.ons l.-'f. . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Electricity is provided for my booth's use: Yes N< <br />I ai 11 piviviumy «n .....------ <br />foods during all times of booth operation: Yes [Xj M <br />I am f <br />135°F: <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />hl in 16-02 f’i'fle 7 oil 1 T^MP EVENT <br />07/1/17 <br /> Other (specify):------------------------------------------ ---------------------------------------------------------------------------- <br />.. r-"n * * ill • j <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />___a„..„_______‘io <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <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 />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 />I.Name of Event: C? <br />I am providing food that is NOT prepared at home: gj Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes F 1 No <br />Name of facility: (V.rF.1 Yn I V Phone: ------ <br />Address of facility:. S .Kiuxhl Aut,__ ______ __________________ _— <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 />The following is information about my organization/business: , <br />Name of organization/business: ■P ToD * 4^ ) C\k-lL ---------------------------------------— <br />(c?//^ ) L ____ Alternate: ( ) ------------------------- <br />List food to be sold or given to the public: PI 4* P I