Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Datefs)- 1 <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <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 />S. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APP <br /> Approved bottled water. <br />21 On-site hose bib that is connected to a potable water source. <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 />e. <br /> Stemo & hotel trays <br />® Steam table & lids <br />H Other (specify) PrtPVL-K En MLL >r HZTtT L <br />SAN JOAQUIN <br />—COUNTY— <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Alternate: ( ) <br />P/W* <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 />1 Name of Event' <br />1868 E. Hazelton Avenue | Stockton. California 95205 I T 209 468-34201 F 209 464-0138 | www.Sjgov.org/ehd <br />EHD 16-02 Pane 7 of 11 TEMP EVENT A! <br />00/26/2023 <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: KT Yes No <br />Name of facility: DI6i DFFP Phone: (Slo ) ^O'SJ.22, <br />Address of facility: PfntwJT pt-. 5»v <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 />S' 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): <br />Electricity is provided for my booth's use: 0 Yes No <br />I am providing an accurate probe thermometei to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation.Til 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 />El Camp stove <br /> Double steamer <br /> Electric stove top <br />The following is information about my organization/business: <br />Name of organization/business: Hesnx? i.uc <br />Df- C/Pr <br />(g,|0)