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Environmental Health Department <br />I <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s):g/3—C- I- kY)1. Name of Event:1. <br />2. <br />oAddress: <br />Phone:) <br />3 List food to be sold or given to the public. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <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 /> Sterno & hotel trays <br />D Steam table & lids <br /> Other (specify) <br />Alternate: ( <br />Li U yv? m U. S <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 TEMP EVENT APP <br />07/3/17 <br />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 /> On-site hose bib that is connected to a potable water source. <br />SAN JOAUUIN <br />-----COl TY------ <br />Other (specify): Pf4? c <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 />u <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^] Yes No <br />Name of facility: ^4 rv\ a o’ Phone: (Zz>^ 37A— 5 <br />Address of facility: ' |~7 STD i H •-5a-| ^>q ? <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 />Name of organization/business: 4-) tl wimu <br />I ^757) S1 <br />37^ <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 />4 y F'ct <T y <br />The following is information about my organization/business: <br />M U V>r\ lx s H-€ /I <br /> Other (specify): <br />Electricity is provided for my booth's use: Yes/0 No <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: Yed'^D No <br />I am providing the following hot temperature controlfor the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top