Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: 1. <br />2. <br />Name of organization/business. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />P»fle 7 of 11 TEMP EVENT APR <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 />7. <br />8. <br />SAN JOAQUIN <br />COUNTY <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />cun Hazeltori Avenue | Stockton. California 952051 T 209 468-3420 | F 209 464-0138 I www siqov orq/ehd <br />Ail food vendors (both for profit and non-profit) ate required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />+ £ <br />The following is information about my organization/business: <br />■ j <br />Phone: Alternate: (S' <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: EfVes No <br />All food is prepared on-site or is from approved commercial facilities: f^Yes No <br />Name of facility: Phone: X <br />Address of facility JL. £7 <br />I am providing a booth with the following: (to proteckny unpackaged food ancTfood-preparation areas from flies, <br />dust and the public) <br />E^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 />Frother (specify): __________________________________________________________________ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />EfApproved bottled water. <br />S^On-site hose bib that is connected to a potable water source. <br />Sather (specify):_______ r ____________________ .______ <br />Electricity is provided for my booth's use: EEfYes Q 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: Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />S^Camp stove [tfStemo & hotel trays <br /> Double steamer Q Steam table & lids <br /> Electric stove top STSther (specify) <br />meats, tamales, cooked beans, rice, <br />df~ <br />Date(s): / 5 J