Laserfiche WebLink
Environmental Health DepartmentA <br />copy of this checklist to <br />1. <br />Date(s): c/ - 2^ <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />‘ • leer.''' <br />HaZeltOn Avenue 1 Stockton. California 95205 I T-209 468-34201 F 209 464-0138 | www.sjcehd.com <br />07/3/17 396 7 “ 11 TEMP EVENT APR <br />l (/■> X <br />N°te: °perati0ns no' to Prau'd0 enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. 9 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />S^pproved bottled water. <br />I am providing food that is NOT prepared at home: H^es No <br />All food is prepared on-site or is from approved commercial facilities: HYes No <br />Name of facility: Phone:£_) <br />Address of facility: <br />' and the puMfc? Wi'h ’'’H0™"9'(t0prOtect my unPa^eged food and food-preparation areas from fl.es, <br />areasfromfoepuMo S",°°,h acceptabte>and separate food and food preparation <br /> Other (specify):________________ <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): y <br />Electricity is provided for my booth's use: (zfYes No ' ——--------------------- ---------— <br />* ra.v,din9 ^accura,t® pr?be thermonJ6}0T to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation: Q Yes No y nazaraous <br />' a{LP,p Vlding the fol,owing hot ^perature control for the hot holding of all potentially hazardous foods above <br /> Camp stove stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top Q other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SANJOAQUIN <br />------COUNTY------ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />mlSuTd0rSJbO? Y PY'and non-Profit)are ^ired to return a signed and completed <br />the festival coordinator three (3) weeks prior to this event <br />1. Name of Event. FofiJ <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address. z 5SS <br />( S ) S p SxPn <br />List food to be sold or given to the public: \. jJcy s <br />Alternate: ( ) <br />c.CVt c(<(? (✓x.