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.___Datefs): 3 " XyI.Name of Event:G'_ <br />2. <br />A-Name of organization/business: <br />\0 K: or o-v-t Qr~. Address: <br />Phone: Alternate: () <br />3.List food to be sold or given to the public:C^OxM- <br />4. <br />A 5. <br />O Other (specify): <br />6. <br />Q On-site hose bib that is connected to a potable water source. <br />> <br />meats, tamales, cooked beans, rice, <br />Sy sty,' ' ’'Jpn1; ■/, ' //'y' <br />I- <br />p <br />7. <br />wk 8. <br />9. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Q Approved bottled water. <br />I <br />« <br />SANJOAQUIN <br />C O U N " Y <br />JSn Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />05/19/19 PCUC 7 Of11 TEMP EVEN1 APP <br />The following is information about my organization/business: <br />All food vendors (both for profit and non-profit) are r <br />the festival coordinator three (3) weeks prior to this event. <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 vail 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 />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 /> 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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove Q Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (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: EZfYes No <br />All food is prepared on-site or is from approved commercial facilities: t'es O No <br />Name of focsib/ twAw’Phone: (A^.) <br />Address of facHrty. Sv. , ( C-A gSSfr?____________________________ <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)