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Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />c A5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />_ Date(s): <br />'"Jd'bl'I? <br /> I /r <br />ehd ?6-02 Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 Page 7 of 11 TEMP EVENT APP <br />required to return a signed and completed copy of this checklist to <br />_______ Date(s); <br />The following is information about my organization/business: <br />Name of organization/business: <br />i?i?- >........ <br />TA ^52^-? <br />Phone: (- I ? I Alternate: (~ / <br />List food to be sold or given to the public: SCfj 0~- fpVh E-Lpy, | x <br />I am providing food that is NOT prepared at home:>PCYesjffiNo <br />All food is prepared on-site or is from approved commercial facilities:^'Yes EJ No <br />Name of facility: . ph?nA. } CQ#- 1^1^ <br />Address of facility:_ (aS pf ' ' ' <br />' ^st^nd the public)1 follOW'n9: (to Protect mV unpackaged food and food-preparation areas from flies, <br />Vl 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 />areas fromthVpubf Sm°Oth W0°d are accePtable) and constructed to separate food and food preparation <br /> Other (specify): <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 />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 /> Other (specify): <br />Electricity is provided for my booth's use: Yes^'No ~ <br />' T” Pr°vidin9 a" accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation:/^ Yes EJ No <br />' a™ PJ°vidin9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />100 i . <br />EE Camp stove E^^Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top other (specify) <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 r. <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Lt ri coin