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^5 0 VQ57 <br />Environmental I lealth Departme'd <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I <br />Phone <br />3 <br />4 I am <br />5. <br />L ; On-site hose bib that is c,onnected to a potable water source <br />9 <br />Xj c- <br />_ Oali'(S) 7 <br />( <br />SAN I0A0UIN <br />. . 1 N|- V <br />1868 E Hazelton Avenue j Stockton. California 95205 | T 209 468-3420 | F 209 461-01 7''. | www s|(|ov orq/ebd <br />fHD 16 0? Pnpc/ofl’ ’IV^' - V'Ai <br />7 <br />8 <br />Fl Sterno & hotel trays <br />[y Steam table & lids <br /> Other (specify) <br />a signed and completed copy of tl ir. Mim id -,1 tn <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following method',. <br />[^Approved bottled water <br /> Other (specify)' ______________ /___________________ _____________ <br />Electricity is provided for my booth's use: rl Yos fl No <br />I am providing an accurate probe thermometef to measure the hot and cold holding . f potentially bazar loin, <br />foods during all times of booth operation. J/J Yos [~] No <br />I am providing the following hot temperahire control for the hot holding of all potentially hazardous foods above <br />135F- <br />[ J Camp stove <br />Li Double steamer <br />U Electric stove top <br />meats, tamales, cooked beans, rice. <br />All food vendors (both for profit and non-prolil) are required to return <br />the lestival coordinator three (3) weeks prior to this evrml <br />I Name of Event feu'/. <br />i he following is information about my organization/business: <br />Name of organization/business <br />Address ..LL__kL., <br /><l°(] ) ..^56 Aileron . <br />List food to he sold or given to the public. z <br />providing food that is NOT prepared al home Yes Q No <br />All food is prepared on-site or is from approved commercial facilities Yes [ '] No <br />Name of facility:^. ^^5 Phone ( 7 <br />Address of facility 5 $ <br />I am providing a booth with the following (to protect my unpackagcd food and food-prep.ii. itioi arnaf from flies <br />dust and the public) <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 clpanable floor (ccncicie. <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />[J Other (specify): <br />Note: 'he only operations not required to provide enclosed booths are those which sell beverage: Torr <br />approved dispensers, or prepackaged foods from approved sources