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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />Phone: <br />List food to be sold or given to the public:' 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 />'^Approved bottled water. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />Em <br /> Sterno & hotel trays <br />^&Steam table & lids <br /> Other (specify) <br />7. <br />8. <br />SAN JOAQUIN <br />COU NT Y- - <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />El ID 16-02 Page 7 of 11 TEMP EVENT A! <br />06/19/19 <br />are those which sell beverages from <br />sources. <br />.Wk_______ <br />ca zmo <br />_____ _ > syg-rs-s-v <br />r i -Tif j Fibs I l^^c. / frriW <br />I am providing food that is NOT prepared at home: j^Pfes No <br />All food is prepared on-site or is from approved conynercial facilities^Q^es No <br />Name of facility: Pn-Si'h’ in -Vood -frAllig.r 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 />^’On-site hose bib that is connected to a potable water source. <br /> Other (specify):___ <br />Electricity is provided for my booth's use:_p^Tes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: j^Yes No <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 <br /> Double steamer <br /> Electric stove top <br />O 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 />^Pother (specify): I <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved <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: July Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: Wok*. N| <br />1^1/2. SbQodkxX An. Lo^Ii / <br /> Alternate: )