Laserfiche WebLink
5f <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.1 Name of Event: <br />2. <br />Address: <br />Phone Alternate: ( <br />3 List food to be sold or given to the public <br />4 <br />5 <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />9. <br />2 <br />ice <br />7. <br />8. <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 />xJTflpproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Sterno & hotel trays <br /> Steam table & lids <br />Q-Other (specify) L <br />) <br />SAN JOAQUIN <br />COUNTY- - - <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page ~ of 11 TEMP EVENT APP <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 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 />[xfbther (specify): <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth's use Q^es No <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 Q^Yes No <br />I am providing tne 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 Pt­ <br />meats <br />The following is information about my organization/business: <br />Name of organization/business: C c /'nar-e/enft. <br />3^0 /Zouk <br />(37C- <br />I am providing food that is NOT prepared at home: Yes Q^o <br />All food is prepared on-site or is from approved commercial facilities 0Ves No <br />Name of facility: '12^ Z*7/'j-C Phone: (^Y) Cp J <br />Address of facility ( j <br />I am providing a booth with the following (to protect rhy unpackaged food and food-preparation areas from flies. <br />dust and the public) <br />tamales/ cooked beans, <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. j <br />Date(s):