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Environmental Health Department <br />1. <br />Date(s): I MH 13^03.5 <br />2. <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAQUIN <br />-"COUN'v----- <br />are those which sell beverages from <br /> Alternate: (-7^ ) ^<7 - *770# <br /> ___________ <br />are required to return a signed and completed copy of this checklist to <br />EHO lo2 Hazelton Avenue 1 Stockton’ California 95205 | T 209 468-3420 | F 209 464-0138 | WAV.sjgov.org/ehd <br />07/01/2024 Pa9® 7 °f 11 TEMP EVENT APP <br /> <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Ail food vendors (both for profit and non-profit) are i^J.. ' ’ <br />the festival coordinator three (3) weeks prior to this event <br />1. Name of Event Loj i Cq f-e i \f r* IL_________ <br />The following is information about my organization/business: <br />Name of organization/business: PmVUv - <br />Address: fio.febV 2-3-40 t=ZMAV<4 <br />Phone: q ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: E) Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: / 5m 5 co Phone: ( ) <br />Address of facility:. <br />1 W'th ‘he followins: (to Protect my unpackaged food and food-preparation areas from flies, <br />uuoi dilu UI6 pUulIC) <br />SnlninTrn™ and .“-'H9 constr,ucted of ei,her wood' “nvas, plastic, similar material and fine mesh fly <br />asnhTri C07let6ly ®nciosln9 °Pen f00d areas 11 wiil also have a smooth and cleanable floor (concrete <br />aras’fromX public acceptable) and POPsfructed to separate food and food preparation <br />KI Other (specify): f on <br />Note: The only operations not required to provide enclosed booths <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 />[J Approved bottled water. <br />KJ On-site hose bib that is connected to a potable water source. <br /> Other (specify): Electricity is provided for my booth’s use: g] Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: S Yes No <br />1 Pr°vidin9 the Allowing 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 Steam table & lids <br /> Electric stove top g] other (specify) V^IaV <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />XpVita's <br />j __________________