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Environmental Health Department <br />Qc-ukI.Name of Event: <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />■ to; weens prior to this event. <br />(7J7 ) <br />List food to be sold or given to the public: <br />SAN JOAQUIN <br />------COUV - <br />control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three^) weeks "priLfto th\s Xpnt tOreturn ^s‘9ned andcompleted copy of this checklist to <br />1. <br />Ha2el,on Avenue I Stockton. California 95205 | T 209 468-3420) F 209 464-0138 i www.sjqov orq/ehd <br />0E™?2024 Pa9e7OM1 TEMP EVENT APP <br />_________ Alternate: ( *2 ) <br />Ki Jita <br /> <br />The following is information about my organization/business: <br />Name of organization/business:P <br />I am providing food that is NOT prepared at home: JSlYes No <br />All food is prepared on-site or is from approved commercial facilities: ® Yes No <br />Name of facility: _ lU mz. rap phone: b773 <br />Address of facility:^(3^ f' '2 <br />' Whh the followin9: <t0 Protect m7 unpackaged food and food-preparation areas from flies, <br />uuoi ana ino puDiic) <br />'Z^.ninT W"h and ,ceilin9 cons,ructed °f oither wood, canvas, plastic, similar material and fine mesh fly <br />!"ehe'?n9: oompletely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />areas from the publicand Sm°°th acceptable) and c°nst™c»ed 1° separate food and food preparation <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 />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 /> Other (specify): <br />Electricity is provided for my booth's use: YesJgjNo <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 JSfrYes No <br />1 a™ Providin9 the Allowing hot temperatilrecontrol for the hot holding of all potentially hazardous foods above <br />135 F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top