Laserfiche WebLink
Environmental Health Department <br />1.1. Ncimo of Event: <br />The following is information about my organization/busincss:2. <br />Address: <br />) V.'ll, poo l Phone: <br />3.List food to bo sold or given to tho public: <:,X\sc\c- <br />4. <br />5. <br />6.Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods: <br />| I Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />I. | Other (specify): <br />fl. <br />meats, tamales, cooked beans, rice, <br />Name of organization/busincss: <br />Hb 0 r\ <br />1H68E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 4G4 0138 | www.sjcehd.com <br />IIIH 160? I'niio/otll irMPIiVIJNTAPP <br />07/3/17 <br />I | Stcrno & hotel trays <br />Steam table & lids <br />I | Ollier (specify) <br />7. <br />8. <br />Alternate: ( <br />V-iUjA <br />Other (specify): <br />Note: Tho only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />SAN JOAQUIN <br />COUN I Y <br />Cu.m;-.. •. ./rpw. /.<.<• <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />C ■>_______________ <br /> CO—_____ <br />Noto: 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 />tho festival coordinator three (3) weeks prior to this event. <br />LODI GRAPE FESTIVAL <br />|^ | A booth with walls and coiling 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 cloanable 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 />I am providing food that is NOT prepared at homo: f^l Yes 17.1 No <br />All food is prepared on-site or is from approved commercial facilities:'^ I Yes T I No <br />Name of facility:Phone: {) <br />Address of facility:.___________________ <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 />Date(S):^±".^3 <br />Electricity is provided for my booth's use: N Yes [ j No <br />I am providing an accurate probe thermometer to measure tho hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes [71 No <br />I am providing tho following hot temperature'control for tho hot holding of all potentially hazardous foods above <br />135OI': <br />I I Camp stove <br />I | Double steamer <br />I | Electric stove top