Laserfiche WebLink
Environmental Health Department <br />Date(s): October 28, 20171. Name of Event: Holiday Bazaar1. <br />The following is information about my organization/business:2. <br />Name of organization/business: Escalon United Methodist Church <br />Address: <br />838-2792Phone: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />TEMP EVENT APP <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 />7. <br />8. <br />2000 Jackson Avenue, Escalon, CA <br />Alternate: ( 209 ) 838-1212 (Jeanette Parsons)(209 ) <br />List food to be sold or given to the public: Soup, Genova bread, pie, coffee, apple cider. <br />SAN JOAOUIN <br />COUNTY <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue! Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 ■— <br />07/3/17 <br />I am providing food that is NOT prepared at home: [Xl Yes [3 No <br />All food is prepared on-site or is from approved commercial facilities: ® Yes No <br />Name of facility: Escalon United Methodist Church Phone: (209) 838-2.792--------------- <br />Address of facility: 2000 Jackson Avenue, Escalon, CA 95320--------------------------------------------------------------- <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) j-N0T A B00TH EVENT) <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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />(3 Other (specify): Event is held in Social Hall of Escalon United Methodist Church------------------- <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 /> Sterno & hotel trays <br /> Steam table & lids <br />® Other (specify) Gas Stove <br />meats, tamales, cooked beans, rice, <br />(xl Other (specify): Water is provided by City of Escalon------------------------------------------------------------------------- <br />Electricity is provided for my booth’s use: Q Yes Q No NOT A BOOTH EVENT <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: O Yes Q No NOT A BOOTH EVENT <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top