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Environmental Health Department <br />£ <br />2. <br />3. <br />4. <br />5. <br />6. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 7 of 11 TEMP EVENT AlTEMP EVENT APPA7/A4 7OAO4 <br />7. <br />8. <br />9. <br />SAN JOAQUIN <br />COUN"V <br />^^5 <br />)________ <br />r7fr\^)^\lv\ <br />and completed copy of this checklist to <br />i___Date(s): (jO / c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />ST »—• <br />1. I.NameofEvent^^lecziKtu)^<: <br />The following is information about my organization/business: <br />Name of organization/business: Th <br />Address: AHau If U <br />Phone: Alternate: ( <br /> <br />I am providing food that is NOT prepared at home: SVes No <br />All food is prepared on-site or is from approved commercial facilities: B'Yes No <br />Name of facility: Phone: ( ) <br />Address of facility:.^ 23 ^n; A j. Tv'.l. K. 1 <br />Ti.2r^!?£9 a Wrth the fo,,ow,n9: (t0 P^ect my unpacxaged food and food-preparation areas from flies, <br />ausi ana the public) <br />J00th 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 />areasafromThetpubHcand Sm0°th W00d are accePtab|e) and constructed to 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 />Efon-site hose bib that is connected to a potable water source. <br /> Other (specify):_____________/ <br />Electricity is provided for my booth’s use: [^Ves No ~ ~ <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: [~XYes No <br />1 a-T Providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />I OO I I y <br /> Camp stove Qotemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top E/Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.