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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Zi.1. Name of Event: <br />2.The following is information about my organization/business: <br />I I <br />Address:^>1^0 <br />Phone: Alternate: () <br />3. <br />4. <br />1 <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />List food to be sold or given to the public: <br />Pf P - <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Name of organization/business: o r-ipcjS <br />] No <br />o measure the hot and cold holding of potentially hazardous <br />s® No <br />rolfor <br />SAN JOAUUIN <br />------COl TY------ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 1 of 11 TEMP EVENT APP <br />07/3/17 <br />Note: Examples of potentially hazardous food include: <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 checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />P^n\l Ft A?- <br /> Other (specify): <br />Electricity is provided for my booth's use: Yesjo <br />I am providing an accurate probe thermometer to i <br />foods during all times of booth operation: Yes <br />I am providing the following hot temperature contr/l for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 />-^^Other (specify): 'ps'y - r- IL a J/ & ____ _____________________________ <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 />"^□Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Yes^No <br />_ Phone: (_________________ <br />ZS? yyy h <g F T <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) <br />3/3 - l^)i^ <br />Date(s) r-- n <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. <br />Name of facility: U- <^,'1 p S • <br />Address of facility: S .