Laserfiche WebLink
Environmental Health Department <br />•< <br />I.Name of Event:1. <br />2. <br />Address: <br />Phono: <br />3. <br />4. <br />5. <br />C I Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by tho following methods:6. <br />[ | Approved bottled waler. <br />9. <br />7. <br />8. <br />Noto: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209'164-0138 | www.sjgov.org/ohd <br />16-02 Pago/olll H:MI’PVCNT API’ <br />06/29/2023 <br />SANJOAOUIN <br />------COUNTY------- <br />Grcnlncss grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> A booth witli walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. Il will also have a smooth and cloanablo 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 />."‘ ■'J/' <br />‘ r <br />L| Slerno & hotel trays <br />^JYI* Steam table & lids <br />L’J 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 required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Wl pm <br />meats, tamales, cooked beans, rice, <br />[□ On-site hose bib that is connected to a potable water source. <br />Olher (specify):. /W ^7//^ <br />Electricity is provided for my booth’s use: [ | Yes [ I No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation:^ Yes [J No <br />I am providing the following hot temperatute control for the hot holding of all potentially hazardous foods above <br />135OF: <br />| J Camp stove <br />L| Double steamer <br />LJ Electric stove top <br />Dato(s):. <br />The following is information about my organization/business: <br />Name of organization/business: 4 FZAZ/ <br />AjpA_^^7^____ <br /> Alternate: <br />List food to be sold or given to the public: <br />t <br />I am providing food that is NOT prepared at homc/ftf Yes □ No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No <br />Name of facility: r/ueA Phone: () <br />Address of facility:___________________________________________________________ <br />I am providing a booth with the following: (to protect my unpackagod food and food-preparation areas from flies, <br />dust and tho public)