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Environmental Health Department <br />i. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />8. <br />9.above <br />meats, tamales, cooked beans, rice, <br />required to return a signed and completed copy of this checklist to <br />Date(s): (f)-' - I ‘ ) <br />EHD Hazelton Avenue 1 Stockton, California 95205 I T 209 468-3420) F 209 464-0138 | www.sicehd.com <br />oJSv PageZofU TEMP EVENT APP <br />SANJOAQUIN <br />------COUNTv------ <br />, dp' <br />’ Greotness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are i_^„:.. ■ <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: /3 *5 <br />Phone: (7^^) “6 Alternate: ( ) <br />List food to be sold or given to the public: ! C'• - ! sp </ /^7/e d. PcYjL <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: (T^Yes No <br />Name of facility: ------------------//Gd __________Phone: ( ) <br />Address of facility:/__________________ <br />1 T a Wi,h ,he followin9: (,o Pratect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />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 />areas fromThe piSicand Sm0Oth W°Od acceptable, and constructed to separate food and food preparation <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths are <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 /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. / <br />Brother (specify): i fa-- <br />7. Electricity is provided for my booth’s use: Yes Nc/ <br />1 T f09 accurate Probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ^fYes No <br />1 the fo,,owin9 hot temperaturea>ntrol for the hot holding of all potentially hazardous foods <br />Q Camp stove JJS-Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.