Laserfiche WebLink
I Health DepartmentEnviro <br />ATION <br />impleted copy of this checklist to <br />Date(s): I.Name of Event: 1. <br />The following is information about my organization/business:2. <br />Kona Ice of Ripon Name of organization/business: <br />P.O. Box 1371 Address: <br />) 302-9238Alt(Phone: <br />List food to be sold or given to the public: Shaved Ice and Flavt 3. <br />4. <br />food-preparation areas from flies,5. <br />Truck [x] Other (specify): <br />those which sell beverages from <br />booth by the following methods:Approved water for drinking, utensil and hand washing will be pre6. <br /> Approved bottled water. <br />~] On-site hose bib that is connected to a potable water source.I <br />:ank on truck <br />Id holding of potentially hazardous <br />potentially hazardous foods above9. <br />tamales, cooked beans, rice, <br />7. <br />8. <br /> A booth with walls and ceiling constructed of either wood, ca <br />screening, completely enclosing open food areas. It will also <br />asphalt, clean tarps and smooth wood are acceptable) and con <br />areas from the public. | <br />Note: The only operations not required to provide enclosed <br />approved dispensers, or prepackaged foods from approvj <br /> Sterno & hotel trays <br /> Steam table & lids <br />0 Other (specify) Nothin! <br />19 464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />similar material and fine mesh fly <br />ith and cleanable floor (concrete, <br />sparate food and food preparation <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468 <br />EHD 16-02 Page 7 Of 11 <br />06/19/19 <br />J No <br />(209 ) 334-2573 <br />Ii11 lllll <br />Note: Examples of potentially hazardous food include <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a <br />the festival coordinator three (3) weeks prior to this event. <br />[x] Other (specify): 3 compartment sink /1 hand washing sir <br />Electricity is provided for my booth's use: Yes 0 No <br />I am providing an accurate probe thermometer to measure th< <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot <br />135°F: <br />0 Camp stove <br /> Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: 0 Yes No] <br />All food is prepared on-site or is from approved commercial facilit <br />Name of facility: Commissary El Gallo <br />Address of facility: 355 N Guild Ave Lodi, Ca. 95240 <br />I am providing a booth with the following: (to protect my unpackaj <br />dust and the public) | <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S <br />( 209 ) 407-7044