Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />TEMP EVENT APR <br />7. <br />8. <br />SAN JOAQUIN <br />_• cS a:-'.- <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHDtioz p^Tortt tfuppvfntw <br />06/19/IS <br />Afl food vendors (both for profit and non-profit) ato required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. . / <br />1. Name of Event:. LortCi Date(s): <br />The following te information about my organlzatlon/buslness: <br />Name of organizatiorVbusiness:. 77i€ <br />Address ~in\\ me-hw/ f4uan$t>Ki, <br />Phone: ! Alternate: ( <br />List food to be sold or given to the public: C ~KJ- eluate f <br />I am providing food that is NOT prepared at home: Yes <br />Alt food is prepared orvsite or is from approved commercial facilities:’£3^'es Q No ■ - - <br />Name of fadlity: f?| | I J*}K/ ki . P^one: <br />Address offacflrty: $< 1^1 [f^U ZP-xA ______ <br />I am providing a booth with the following: (to protect my unpackaged food and foodrpreparation areas from flies, <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, simBar materia! and fine mesh.fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparafim <br />areas from the public. <br />^Other (specify): J - <br />.... ..... <br />Note: The only operations not required to provide enclosed booths are those which' sel! beverages from <br />^proved dispensers, or prepackaged foods from approved sources^ t j.;’';.■ <br />■■ : '• '• ■ ■ '■ <br />Approved water for drinking, utensil and hand washing will be provided .in my booth by the following methods: . <br />^[^pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />pother (specify): <br />Bectridty is provided for my booth's usetjgpYes 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 operationi’S'YesO No . '; . <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove O Sterno & hotel trays <br /> Double steamer Q Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.