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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />....Datefs):.8!?.!2’!5^?41. Name of Event:1. <br />The following is information about my organization/business:2. <br />Name of organization/business. <br />Address: <br />Alternate: (Phono: ) <br />L ist food to bo sold or given to the public: 3. <br />4. <br />5. <br />I | 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 />I On-site hose bib that is connected to a potable water source. <br />9. <br />\'.x( C V W W.i’C <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <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 />1868 I.. I lazellon Avenue | Stockton, California 9520b | T 209 468-3420 | F 209 464 0138 | www.sjcchd.com <br />1:110 16 02 1’000 7 0(11 n MP I VI N I API’ <br />0//3/17 <br />______ <br /> VX^Q.- J&C ^£^13 <br />SAN JOAQUIN <br />COUNfY <br />i . ■. ..1 i< '. ■. ■; . /i. i ■ <br />I am providing food that is NOT prepared at homo: |^| Yes |. J No <br />All food is prepared on-site or is from approved commercial facilities: |^] Yes | | 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 flics, <br />dust and the public) <br />NA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />sdroening, 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 />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 throe (3) weeks prior to this event. <br />LODI GRAPE FESTIVAL. <br />I | Sterno & hotel trays <br />Steam table & lids <br />[XOther (specify) <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />[ | Other (specify):_______ _ _ <br />I Joctricity is provided for my booth's use: Ml Yes I | No <br />I am providing an accurate probe thermometer to measure (he hot and cold holding of potentially hazardous <br />foods during all times of booth operation: lyj Yes | ,| No <br />I am providing the following hot temperature' control for tho hot holding of all potentially hazardous foods above <br />135°F: <br />I | Camp stove <br />| | Double steamer <br />I | Electric stove top