Laserfiche WebLink
Environmental Health Department <br />required to return a signed and completed copy of this checklist to <br />Date(s): 1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />No <br />lercial facilities: <br />8. <br />ETVes No <br />leasure the hot and cold holding of potentially hazardous <br />SAN JOAQUIN <br />-—-COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />PA <br />Note: The only operations not required to provide enclosed booths are <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 /> Approved bottled water. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420, F 209 464-0138 | www sicehd com <br />07™q176’02 Page 7 of 11 TEMP EVENT APP <br />3-Tes No <br />Phone: <br />Q<5n-site hose bib that is connected to a potable water source. <br /> Other (specify): ________________ <br />Electricity is provided for my booth’s use: <br />I am providing an accurate probe thermometer^icxfir <br />es No <br />^trol for the hot holding of all potentially hazardous foods above <br />I am providing food that is NOT prepared at home: [HYes^J <br />All food is prepared on-site or is from approved coi <br />Name of facility: <br />Address of facility: I <br />1 ^dusTa^Yth9 3 W'th fOllOW'n9: ^t0 protect my unpackaged food and food-preparation areas from flies. <br />LTStenjO'tTnotel trays ' <br />E^tearn table & lids <br /> Other (specify) <br />All food vendors (both for profit and non-profit) are i , ' '' <br />the festival coordinator three (3) weeks prior to this event. <br />1 .Name of Event: -G Xrr~ic^z£7- <br />The following is information about my organization/business: <br />Name of organization/business-^^ <br />Address: 1 K-k 3>’ <br />(2^) <br />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 />1_)_ Alternate: (Zi^T) / (* <br />List food to be sold or given to the public: "Tl" |~~ It <br />iwrc 4-'"r <br />foods during all times of booth operation:!CT <br />I am providing the following hot temperature c< <br />135°F: <br /> Camp-stove <br />El5ouble steamer <br /> Electric stove top