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I <br />1.1. Name of Event <br />2. <br />Address: <br />Phone: <br />aList food to be sold or given to the public:3.o <br />(AcrV \aS <br />4. <br />5. <br />O Other (specify): <br />Approved water tor drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 154)2 PagaTcfll TEMP EVENT APP <br />06/29/2023 <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 wifi 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 foe 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 />7. <br />8. <br />Name of organization/business:_______ <br /> Stemo & hotel trays <br /> Steam table & lids <br />Q Other (specify) 1 <br />'-COUNTY------ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />^7^ <br />The following is information about my organization/business: <br />Mt <br />C-f ^^'-7 fa <br /> Alternate: ( 2^^^) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes 0No //(A <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: Yes [21 No a// A <br />I am providing foe following hot temperature controffor the hot holding of aR potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br /> Etectric stove top <br />1 am providing food that is NOT prepared at home: IJS Yes Q No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No , <br />Name of facility: /// Phone: (^f) <br />Address of facility: z <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 />Date(s): -