Laserfiche WebLink
SAN`,JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Grc•otness gror+s here. <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 checklist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> . - r / <br /> t. 1.Name of Event: Date(s): � �p 27 <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organizationlbusiness: <br /> Address: O ,{ <br /> Phone: ( 6s`� 3 t Z` �" Alternate: <br /> 3. <br /> 3. List food to be sold or given to the public: D Ra rumlto64t f /r S Y., I <br /> 4. 1 am providing food that is NOT prepared at home: Yes o <br /> All food is prepared on-site or is from approved c mmercial fal:ili es: Yes❑No <br /> Name of facility: /-1a 1l 2 /-I a PInone: 3 J12 I �S <br /> Address of facility: 'l9 O ' ,0 F d-may = tZL�,S 772 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <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 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 /> Other(specify): Cit k @ <br /> Note: The only operations not required to provide enc osed booths 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 /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source, <br /> �]Other(specify): (ne (/k P r� f► 6 �9�/ <br /> T Electricity Is provided for my booth's use:❑Yes fZ No <br /> 8. 1 am providing an accurate probe thermometer to measure the Pot and c td I�8lding of potentially hazardous <br /> foods during all times of booth operation: QYes❑No y A eA/�G� <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑ Sterno&hotel trays <br /> F-1Double steamer L1Steam table&lids ���fell <br /> ❑Electric stove top Rf Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E, Hazelton Avenue 1 Stockton, California 952051 T 209.488-3420 1 F 209 464-0138 1 www.sjgov.org1ehd <br /> EHO 1"2 Page 7 of 11 TEMP EV ENT APP <br /> 07101!2025 <br /> Scanned with <br /> ®CamScanner <br />