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Environmental Health Department <br />1. <br />2. <br />Phone: Alternate: () <br />List food to be sold or given to the public: 3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice.Note: Examples of potentially hazardous food include; <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />7. <br />8. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />SANJOAOu.N <br />' ------COUNTY------- <br />G.' <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420) F 200 464-0138 | www.sjcehd.com <br />Page 7 or 11 TEMP EVENT APP0773/17 <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):________________ _____ ___________________________ <br />Electricity is provided for my booth's use: Yes No ’ — <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all tones of booth operation: ig Yes No <br />I am providing the following hot temperature control for the hot holding ofoall potentially hazardous foods above <br /> Camp stove stemo & hotel trays ' <br /> Double steamer steam table & lids <br />O Electric stove top other (specify) <br />I am providing food that is NOT prepared at home: F/f Yes D No <br />All food is prepared on-site or is from approved commercial facilities: [7f Yes Q 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 pubfic) <br />ta-A booth with walls and ceding 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 />Address: ________ <br />(510 ) fit) <br />AH 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 /> l.Name of Event Dox] Aatefs)- <br />The following is information about my organization/business: <br />Name of organization/business: Pl