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Environmental Health Department <br />All food vendors (both for profit and non-profit) arc required to return a signed and completed copy of this checklist to <br />SEP 14-17, 202.31. Date(s): <br />2. <br />Alternate: ( <br />3. <br />4. <br />5. <br />( | Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />7.. <br />8. <br />A <br />meats, tamales, cooked beans, rice, <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods; <br />[. | Approved bottled water. <br />.kfOn-site hose bib that is connected to a potable water source. <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | I- 209 464 0138 | www.sjcehd.com <br />IHD1G02 I'.i(|o7of 11 II MI’liVINI Al’l’ <br />07/3/17 <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: «-ODI GRAPE FESTIVAL <br />SANJOAOUIN <br />COUN I Y <br />1 i- . .// civ, Ik «<• <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />HH-su^o-iUiotci trays <br />I | Steam table & lids <br />yj/f Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at homo: 0Yes f"! No <br />All food is prepared on-site or is from approved commercial facilities: p'fYes | | No <br />Name of facility: ■, Phone: ( ) <br />Address of facility:. ~~~~—__________ <br />I am providing a booth with the following: (to protect my unpackaged foo’d and food-reparation areas from flies, <br />dust and the public) <br />J/fA booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. It will also have a smooth and clcanablc floor (concrete, <br />asphalt, clean tarps and smooth wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />[ | Other (specify): <br />l-Jectricity is provided for my booth's usoJxFVes LI 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 opcratiorV Mros | J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />Li Cm up hIOVO <br />I | Double steamer <br />I | Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: Q tYtry V" D C <br />Address: Ok.Q.\Vec^c/e <br />Phono. (%>“/ <br />11st food to be sold or given to the public: SCWC- ICC OrCQfYY 1