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EnviiironmentaS HeaSth Department <br />Sr1.1. Name of Event: <br />2. <br />Address: <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 methods:6. <br />U Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />7. <br />8. <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />•i. <br />IzdlWZ <br />' ■ SANJOAQUIN <br />-------COUNTY------ <br />,.v ■ Gfcuine.ss yry.vs Iseie. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue I Stockton, California 95205 [ T 209 468-3420 1 F 209 464-0138 1 wvyvj.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT <br />07/3/17 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Name of organization/business: <br />CV, <br />( 7^^) ' gCo1! Alternate: (2-^^ ) " (pOOQ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes j^No <br />All food is prepared on-site or is from approved commercial facilities: Yes 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 /> 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 />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) week^prior to this event, a <br />nfine.Cs I 'am&T <br /> On-site hose bib that is connected to a potable water source. <br />■I Cai'Vw- <br />,: WYes No <br />I am providing an accurate probe therrriometgr to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation. <br />I am providing the following hot temperate <br />135°F: <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <br />Date(s): <br />5[l5 ' <br />pother (specify): <br />lectricity is provided for my booth's use: <br />ometet <br />n: KfYes No <br />:<Xecbntrol for the hot holding of ail poteniiaily hazardous foods above