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Environmental Health Department <br />(i'. <br />I.Namc of Event:1. <br />2. <br />3. <br />4. <br />5. <br />( J Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />| I Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />II Ml-1 VI Ml API’ <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 />( | Sterno & hotel trays <br />I | Gleam table & lids <br />( | Other (specify) <br />7. <br />8. <br />SAN JOAOUIN <br />COUNTY <br />.. •. /i.u- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 I ■. I lazolton Avenue | Stockton, California 95205 | T 209 468- 3420 | E 209 46'1-0138 | www.sjcehd.com <br />f i if> in o? i’ago f or H ::‘: ■K:: <br />OZ/3/17 <br />All food vendors (both for profit and non- profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />LODI GRAPE FESTIVAL ___J)ate(s):.s£pJ?J5.2224 <br />| booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and clcanablo 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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />| yf On-site hose bit) that is connected to a potable water source. <br />I ,| Other (specify): ____________________ <br />f Toctricity is provided for my booth's use: (3, Yes [ J 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 | J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />| | Camp stove <br />| | Double steamer <br />| | Electric stove top <br />T he following Is information about my organization/business: <br />Name of organization/business: ,C4Xll-ioTraL^_-_l(L2.„ - <br />Address: 1 &.. -i.LJkXvfvl -C.---------------------------------- <br />Phone: (/C)6\)__LI Alternate: ( )____ <br />List food to be sold or given to the public: CjCar(\| CbHUb <br />I am providing food that is NOT prepared at home: Yes [ .] No <br />All food is prepared on -site or is from approved commercial facilities: iX/es |.. | No <br />Name of facility: _____Phone:.()— -------------- <br />Address of facility:___________ <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)