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i <br />Environmental Health Department <br />i. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />1 include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />foods during all times of booth operation: Yes No <br />I am [ <br />135°F: <br />Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food <br /> Other (specify):------------------------------------------------------------------------------------------------------------------------- <br />Note: The only operations not reguired 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 />tzfApproved bottled water. <br />tzf On-site hose bib that is connected to a potable water source. <br /> Other (specify^:___ ________ _______ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure <br />~ i i»> i i k i <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />Stemo & hotel trays <br />j^Steam table & lids <br /> Other (specify) <br />SANJOAOUIN <br />------COUNTY------ <br />Greotness crows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^rg/ehd^ <br />EHD 16-02 Page 7 of 11 <br />AR/aa/onoi <br />meats, tamales, cooked beans, rice, <br />^<5^/6____________ <br />(2/0^ ) ' J/ ^33 Alternate: ~87<5 J <br />List food to be sold or given to the public: ftjLo&C) / <br />I am^providing food^th^N^bJOT prepared at homefo^es^Q No <br />All food is prepared on-site or is from approved copmercial facilities:lZfYes No //^/;? <br />Name of facility: &(£^06 Phone: <br />Address of facility:.ttO) -p/ilt/h.daJjL YVlocUon <29______________— <br />I am providing a booth witt/the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />fyl/X 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 />All food vendors (both for profit and non-profit) are reguired to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: 11335 Jtcl• <br />>c'r - <br />,n