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Environmental Health Department <br />I.Ncimo of Event:1.Dalo(s): <br />2. <br />Phono: <br />3. <br />4. <br />5. <br />| | Other (specify): ' <br />Approved water for drinking, utensil and hand washing will ho provided in my booth by the following methods:G. <br />| | Approved bellied waler. <br />9. <br />moats, tamales, cooked beans, rice, <br />I' <br />Note: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <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. Il will also have a smooth and cloanablo 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 />1H6G IHazelton Avenue | Stockton, California 9!»205 | T 209 468-342.0 | F 209464 0138 | www.sjgov.org/ohd <br />HU) 16-02 I’iigozcrfll H MP IVI N! AH’ <br />0(5/29/2023 <br />7. <br />8. <br />SANJOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I | Slorno & hotel Irays <br />Steam table & lids <br />| | Other (specify) <br />All food vendors (both for profit and non-profit) arc required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />LUJ2J.. 6/A Ft 1' YA( <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />( | On-site hose bib that is connected to a potable waler source. <br />................. _ ______ <br />Electricity is provided for my booth’s use: | j 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: M Yes I I No <br />I am providing the following hot lomporatuta control for the hot holding of all potentially hazardous foods above <br />135°F: <br />I | Camp stove <br />| | Double steamer <br />[ 11 •Joctric stove top <br />The following is information about my organization/businoss: <br />Name of organization/businoss: _ . A mavZA _______ <br />Address: . <4 _alZA .. ___ <br />cM ___ Alternate: TW-farf__ <br />11st food to bo sold or given to the public:A*- _ <br />I am providing food that is NOT prepared at homc:/?ffYes | 1 No <br />All food is prepared on-site or is from approved commercial facilitios:jXf Yes [ J No <br />Name of facility: Phono: () <br />Address of facility: _____________________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public)