Laserfiche WebLink
U'JM— T,- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i <br />3. List food to be sold or given to the public: <br />Note: <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue* Stockton* California 99205 <br />Biuineu: (209)468-3420 <br />Alternate: 7 <br />4. I am providing food that is NOT prepared at home: [txQ Yes [ ] No <br />AIL food is prepared on-site or is from approved commercial facilities: MYes [ ]No <br />Name of facility: Phone: $Z- <br />• Address of faciiityr^2Z^^£^ <br />5. lam providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />Date(s): <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />checklist to the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: <br />2. The following is information about my organization/bi <br />Name of organization/business: <br />Address: <br />Phone: jgoy 7^? - <br />WA <br />mesh <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[ j Other (specify): <br />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 />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br />methods: <br />M Approved bottled water. <br />pd On-site hose bibthat is connected to a potable water source. <br />[ ] Other (specify): <br />7. Electricity is provided for my booth’s use: f/] Yes [ ]No <br />8. lam providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all time of booth operation: [ ]No <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />i above 135 degrees Fahrenheit: <br />' ' Camp Stove [^Double steamer [] Electric stove top <br />[ ] Stemo & hotel trays [ ] Steam table & lids [ ] Other (specify): <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products.