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Environmental Health Department <br />//Uy 15- <br />1. <br />2. <br />Name of organization/business: <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br /> Other (specify):__ <br />only operations not required to provide enclosed booths <br />1868 E. Hazelton Avenue | StocKton, California 95205 I T 209 468-34201 F 209464-0138 | <br />EHD 16-02 Psge 7 of 11 <br />07/3/17 <br />the hot and cold holding of potentially hazardous <br />'foods during all times of booth'operation: YesQ No <br />1 am | <br />135°F: <br /> Camp stove <br /> Double steamer ■ <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />7. _ . <br />8. .! am providing an accurate probe thermometer to <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home^] Yes No <br />A!) food is prepared on-site oris from approved commercial faciiitieSjjg'Yes No <br />Name of facility: Phone. £-------) - <br />famprovMing'a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food prepara .o, <br />areas from the public. <br />SANJOAOUIN <br />, •' ------COUNTY------- <br />GfCUhlfSS ytv.’/s hi'M-. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist io cAll food vendors (both for profit and non-profit) are required to return <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: <br />The following is information about my organization/business: <br /> SAao*?____ <br />\O‘ — <br />\ VA "1____________ Alternate^ )_--------------------------— <br /> Other (specify)::-------------V------— ------------ <br />Electricity is provided for my booth’s use: £] Yes U No <br />• ----------*— ‘t measure <br />providing theSng te^^turo oon“o^ the hot hoiding of aH potenW hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify)