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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />6.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 />8. <br />9. <br />(^TA 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 />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 />SAN JOAQUIN <br />C OUN'Y <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: lAx (c\C C <br />) <br />A ; vec|ccmj <br /> Other (specify): X"__________________________________________ <br />Electricity is provided for my booth’s use: Yes [l^o <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 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />1 on-site or is from approved commercial facilities: Q^Yes No <br />C H ^5V \nvAr\k aS fa IpUje: (i <br /> Sterno & hotel trays <br /> Steam table & lids . I <br />0Other(specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <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 />j iiiis evern. , <br />Date(s): CbV n "I , 7073 <br />The following is information about my organization/business: <br />Name of orqanization/business: b k Achen <br />Address: J (-/V C? A Wlf* ft'C . I *'Vr V '-A < ( , <"l‘__________________ <br />Phone: ('32^ ) Alternate: ( <br />List food to be sold or given to the public: 11-Y~,\1 OCT 5 <br />I am providing food that is NOT prepared at home: Yes [vf No <br />All food is prepared on-site or is from approved pommercial facilities: <br />Name of facility: j <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 public)