Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />requ-red to return a signed and completed copy of this checklist to <br />1.1. Name of Event:Date(S). Friday. May 24th <br />2. <br />Address <br />Phone:(Alternate: () <br />List food to be sold or given to ir.o public Chicken, steak, nee, kimchi.salaa3. <br />4. <br />2096391515 <br />5. <br />6 <br />9. <br />meats, tamales,vcooked beans, rice, <br />7, <br />8. <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for dnnking. utensil and hand washing will be provided in my booth by the following methods <br /> Approved bottled water <br />SAN JOAQUIN <br />COUNTY----- <br />Ths following is information about my organizationi'busmess <br />Name of organization/business Teppanyaki 2 Go <br />10423 Henshaw Dr.. Stockton, CA 95219 <br />All food vendors (both for profit and non-profit) are i <br />the festival coordinator three (3) weeks prior to this event. <br />Kaiser Stockton Lunch <br />O On-site hose bib that ts connected to a potable water source. <br />0 Other (specify): Water tanks on the mobile food facility <br />Electricity is provided for my booth’s use 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cotd holding of potentially hazardous <br />foods during all times of booth operation 0 Yes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays <br />O Double steamer 0 Steam table & lids <br />O Electric stove top 0 Other (specify) <br />i am providing food that is NOT prepared at home: Q Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities. 0 Yes O No <br />Name of facility Teppanyaki2Go Phone: j[ <br />Address of fadtity- 2900 E .Harding Way _ <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 />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 /> 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 deanabte 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 />0 Other (specify): Mobile Food Facility _________________________ <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464 0138 I <.vvAv.sicehd.com <br />EHbtS-ez Passrjrftl TEMP EVENT AFP <br />) 209-639-1515