Laserfiche WebLink
Environmerrtai Heaith Department <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />TEMP EVEhTT APP <br />7. <br />8. <br /> Stemo & hotel trays <br /> Steam table & lids <br />@ Other (specify) <br />SAN JOAQUIN <br />COUN’ '' <br />meats, tamales, cooked beans, rice, <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 PaS® 7 of 11 ™." E'.^.T -*J <br />07/01/2024 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are i ‘ <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />are required to return a signed and completed copy of this checklist to <br />1. Name of Event:^AITAIN MUSS Of M Date(s): <br />The following is information about my organization/business: <br />Name of organization/buslness:S <br />. I Tv__________ _____ <br />(2M} 5^14 Alternate: (^16?) 58S- Hl <br />List food to be sold or given to the public; <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 />0 Other (specify): ?? <br />Electricity is provided for my booth’s use:® Yes B No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during ell times of booth operation:^¥es No <br />I am providing the 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 <br />I am providing food that Is NQT prepared at home: IQ Yes Q Nn 3 <br />All food is prepared on-site or Is from approved commercial facilities:® Yes No <br />Name of facility; GtallO Phone: (Xfl.) Address of facility: bl igi iiM <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 /> 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 />asphaft, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />□ Other (specify): -YVlXX 41 <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.