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Environmental Health Department <br />All food vendors (both for profit and non- profit) are required to return a signed and completed copy of this checklist to <br />1. <br />2. <br />Address: <br />Phono: <br />3. <br />4. <br />)_____ <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />7. <br />8. <br />SANJOAOUIN <br />GOUNIY <br /><• hi <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868I-. Itozolton Avenue I Stockton. California 962051^209 «8-3420 | F 209 4640130 I www.sjcehd.co^^^ <br />O//3/I/ <br />screening, completely enclosing open food <br />asphalt, clean tarps and smooth wood are r <br />areas from the public. <br />Other (specify): <br />Note: The only operations not required to provide enclosed booths <br />meats, tamales, cooked beans, rice, <br />| | Approved bottled water. <br />[ | On-site hose bib that is connected to a potable water source. <br />Other (specify):_________________ <br />l.iloctricity is provided for my booth’s use: In Yes I I No <br />I am providing an accurate probe thermometer to measure <br />1 XX9 fX hoi holding of ail potontlafiy hazardous foods above <br />135°F: <br />[ | Camp stove I I Storno & hotel trays <br />[ 11 )ouble steamer I I Steam table & lids <br />[ | l-Jectric stove top /’I Other (specify) ( <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />the festival coordinator throe (3) weeks prior to this event. <br />1. Name of Event: .WDI GRAPEF^L^L <br />The following Is information about my organization/business: <br /> Name of organization/business: - <br />^3:2^ - Alternate: (9^ )^2kLt'_6...Y1L—- <br />1 .1st food to bo sold or given to the public: —bs>_S_L------------------- <br />I am providing food that Is NOT prepared at home: b^P/es 171 No <br />All food is prepared on-site or is from approved commercial facilities: j^Yes LI No <br />Name of facility:phono; -(- <br /> ?am providing a booth with the following:7to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />n A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine moshi (ly <br />II areas. It will also have a smooth and cleanablc floor (concrete, <br />acceptable) and constructed to separate food and food preparation <br />_ _________ <br />are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: