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Environmental Health Department7 of 11 <br />1. <br />2. <br />Address: <br />) Phone: <br />3. <br />4. <br />73^^? <br />\AjcL <br />5. <br />6. <br />I <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />: W- <br />lisps' <br /> Other (specify):------------------------------------------------------------------------- <br />Note: The only operations not required to provide enclosed booths <br />SAN JOAQUIN <br />------COU NTY <br />( h fill rw,-> ijKlvv. l>Cr.‘. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov ora/ehd^ <br />EHD 16-02 Page 7 0(11 <br />07/01/2024 <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: /pr/f' M ^Tatefs): <br />The following is information about my organization/busipess: <br />Name of organizalion/business: <br /> <br /> (m7/ ^7 Alternate: ( )---------- ------------ ------- <br /> List food to be sold or given to the public: ^^7/Zz V <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 El No <br />Name of facility: b^t Phone: n <br />Address of facility: \AJ<W . <br />I am providing a booth with the following: (to protect my urtfacKaged food and food-pre|Saration areas from flies, <br />dust and the public) <br />K3 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 />; 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 /> a Other (specify): Aoff tAAo/ <br />Electricity is provided for my booth's use: Yes U No y <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: Yes No u ok™* <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 Sterno & hotel trays <br /> Double steamer 0 Steam table & lids <br />Q Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.