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Environmental Health Department <br />5/05/2023Date(s):1.1. Name of Event: <br />2. <br />Address: <br />( 209 922 3782Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />7, <br />8. <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 />!x! Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />The following is information about my organization/business: <br />Name of organization/business: FanCySW66tS_209 <br />419 Davitt Ave Oakdale Ca 9536 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Ail 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 />pow bww aschwd <br />- ■ Alternate: ( ) <br />uas Frescas^nd Cotton Candy <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwW.sjgov.org/ehd <br />EHD 16-02 Page? of 11 TEMP EVEN i APP <br />06/19/19 <br />I am providing food that is NOT prepared at home: B Yes O No <br />AH food is prepared on-site or is from approved commercial facilities; Yes No <br />Name of facility: ■■ . ■ A . Phone: ( ) - <br />Address of facility:____ _ _ ______________ <br />lam providing, a booth with the following: (to protect my unpackaged 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 and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Other (specify): -- ,. .. . ...w . <br />Electricity is provided for my booth’s use: Yes |X| Mo <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 operation: ® Yes E] No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135“F: ■ <br /> Gamp stove Stemo & hotel trays <br /> Double steamer ■ ■ • ■ Steam table & lids <br /> Electric stove top Other (specify) <br />t. SANJOAQUIN <br />■.— COUNTY-— <br />■' C he'c. <br />TEMPORARY FOOD VENDOR’S APPLICATION