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Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />G. <br />LI Approved bottled water. <br />|...I On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />ri MI’HVENr APP <br />7. <br />8. <br />The following is information about my organization/business: <br />.' J? Q/t <br />SANJOAQUIN <br />c: <.) i j n i y <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcelid.com <br />PHI) 16 02 P.iflo 7 of 11 TEMP EVEN! <br />07/3/17 <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 (his event. <br />1 .Name of Event: J ODIGRAPE: FESTIVAI. <br />L.l Other (specify):_________________ __________________________________________—----------------------- <br />I am providing an Accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Y. " 22* <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />| | Sterno & hotel trays <br />| | Steam table & lids <br />L'| Other (specify) <br />Electricity is provided for my booth's use: LJ Yes L.l No <br />foods during all times of booth operation: | ”J Yes I J No <br />I am | <br />135°F: <br />( | Camp stove <br />|. | Double steamer <br />LJ Electric stove top <br />Dato(s): SEP 12-1 <br />(2I Other (specify):__ __ ------------------- ------------------------- <br />Noto: 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 />I am providing food that is NOT prepared at home: | J Yes | I No <br />All food is prepared on-site or is from approved commercial facilities: L^Yes | J No <br />Name of facility: Phone:.(-- ------- <br />Address of facility 4^-------------------------------------------------------■ <br />I am providing a bootti with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />r IA 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 />areas from the public. <br />Name of organization/business: <br />. f-a ■ <br />Phono: ( Alternate: ( ) . <br />List food to be sold or given to the public: &