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"• Environmental Health Departmel't <br /> : t SAN JOAQUIN <br /> -----COUNTY . <br /> Grouoicss rgrows hetc. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklistto s <br /> the festival coordinator three(3)w eks prior to this event, /1 n z� <br /> 1. 1.Name of Event' L��i � _ Date(s): <br /> 2. The following is information about my organizationtbusines_s: <br /> Name of organization/business: <br /> Address: t <br /> Phone: (dip } Alternate:{ ) <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes[J-No <br /> All food is prepared site r is from a roved col facilities: Yes[rNa <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5. 1 am providing a booth with the following:(to p4ASt my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> D A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh[ly <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 /> -ff0ther(specify): <br /> Note: The only operations of required 10 provide enclose ooths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking,utensil and hand washing will be provided In my booth by the following methods: <br /> /f s <br /> El Approved bottled water. <br /> ) <br /> El On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7, Electricity is provided for my booth's use: Ye No ' <br /> of potentially hazardous <br /> 8, ! am providing an accurate probe thermometer to measure the hot and cold holding <br /> foods during all times of booth operation:❑Yes•B-No ' <br /> 9. f am providing the following hot temperature control for the hot holding of all potentlally hazardous foods above <br /> 135'F; <br /> Ll Camp stove D Sterno&hotel trays ` <br /> D Double steamer D Steam table&lids <br /> D Electric stove top D Other(specify) <br /> Note: Examples of potentially hazardous foot) Include: Irtieats, tamales, cooked boans, rice, <br /> vegetahles,potato salad,eggs,and dairy products. <br /> 9868 E.Hazelton Avenue I Stockton, California 852051 T 209 468-34201 F 208 464-0138 j www.sjcehd,com <br /> EHn 4602 r'nga 7 0l 11 TEMP EVEN1 APV <br /> 07/3117 <br />