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Environmental! Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />7. <br />8. <br />SA booth with walls and celling 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 />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 />SAN JOAQUIN <br />c:ouk-v <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />'^[Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 1M2 Pa«e 7 0111 TEMP EVENT <br />07/01/2024 <br />) <br />All food vendore (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. <br />1. Name of Event j/ddUTAM Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: CAfcV <br />Address: 10*02.1 Qk <br />(*2£A ) 'IWv Alternate: ( <br />List food to be sold or given to the Dublfc:0A\O0Onik^\V^.^>^ A <br />I am providing food that Is NOT prepared at home: ^Yes No <br />All food Is prepared on-she or is from approved commercial facilities: I^Yes No <br />Name of facility;Phone: (, ) <br />Address of facility:_________________________________________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br /> Other (specify): <br />Electricity is provided for my booth's use: O Yes’SjNo <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: BYes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />.ISS’F: <br />El Camp stove D Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />meats, tamales, cooked beans, rice,