Laserfiche WebLink
Environmental Health Department <br />Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />15. <br />O Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />1. <br />8. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />jX^Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />7 <br />■ SAN JOAQUIN <br />' -------COUNTY------- <br />Greotnefs grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are <br />e estival coordinator three (3) weeks prior to this <br />1. <br />required to return a signed and completed copy of this checklist to <br />event. <br />1 ■ Name of Eventf%xllj fclKD, |£jl FLd <br />The following is information about my organization/business: <br />Name of organization/business: rb_4 Ci '/-Ci <br />List food to be sold or given to the public: <br />• ar.. <br /> Other (specify):__ _________________________________ <br />Electricity is provided for my booth's use: Yes 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 operation: felYes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br />■/x3x3 _______________ <br /> Alternate: ( )___________________ <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities^I^Yes No <br />Name of facility: Cz /a Phone: ( ) <br />Address of facility: p* c t'd'c- y <br />I 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.