Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />areas from the public. <br /> Other (specify):__ <br />List food to be sold or given to the public: <br />SAN JOAQUIN <br />------COUNTY------- <br />) <br />bo 44/C <br /> Alternate: ( <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: Yes 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: Yes No <br />1 Vidin9 the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top (Zither (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Zfves No <br />Name of facility: Phone: (3r>7 ) 7 <br />Address of facility: / 6 £ 5~'-j So <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 />Vca\ |lf c <br />Note: The only operations not required to provide enclosed booths are <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 />ETApproved bottled water. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />07/01/2024 <br />All food vendors (both for profit and non-profit) are 1 ’’ <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: £ fl 4 r C <br />The following is information about my organization/business: <br />Name of organization/business: 6 S f <br />Date(s): /