Laserfiche WebLink
Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />1 <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />7. <br />8. <br />[^Approved bottled water. <br />(2POn-site hose bib that is connected to a potable water source <br />SANJOAQUIN <br />' ------COUNTY------ <br />Greatness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />> are those which sell beverages from <br />sources. <br />i0 'C ■. <br /> Other (specify): __________________ <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved s__. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Other (specify): ---------------------------------—=—--------- <br />Electricity is provided for my booth's use: Lp Yes U No <br />I am providing an accurate probe, thermometer to measure <br />I aXS hot holding of al! potentially hazardous foods above <br />135°F: _ <br /> Camp stove Sterno & hotel trays <br /> Double steamer O Steam table & lids cSt—' <br /> Electric stove top p Other (specify) a <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <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 checkiisl.to <br />the festival coordinator three (3) weeks prior to this event. ' <br /> I.Name of Event: Date(s): <br />The following is information about my organization/business: <br /> Name of organization/business: <br />Address: ---------------------------- <br /> (~7 Alternate: (J2^/ ) 3^) <br /> List food to be sold or given to the public: # A iCY.d— <br />I am providing food that is NOT prepared at home: Yes O No <br />All food is prepared on-site or is from approved commercial facilities:'SfVes No <br /> Name of facility:Phone. [ <br /> famprovidingabooth with the following: (to protect my unpaokaged food and food-preparation areas from flies, <br />dust and the public) <br />■®A booth with walls and ceiling constructed of either wood canvas, plastic, similar material ancI fine mesh fly <br />screeninq completely enclosing open food areas. It will also have a smooth and cleanable 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 />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgoworg/ehd^ <br />EHD 1M2 Page 7 of 11