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• T;- <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> No <br />to measure the hot and cold holding of potentially hazardous <br />Yes O No <br /> Stemo & hotel frays <br /> Steam table & lids <br />Esther (specify) <br />meats, tamales, cooked beans, rice, <br />UMII 'JUMVU I H .................. <br />' ' —COUNTY------ <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />1.Name of Event: l5lAl\f&5 Cb <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes <br />I am providing an accurate probe thermometer'' <br />foods during all times of booth operation: 0' <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 />Q Double steamer <br /> Electric stove top <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^ehd <br />7 wf n I teMr tVtnl I ArrEHD 16-02 Page 7 or 11 <br />06/29/2023 <br />7. <br />8. <br />3* <br />Date(s): 4/g7- <br />The following is information about my organizatiOT/business: <br />Name of organization/business: <br /> Alternate: ( )_______________ <br />List foocfto be sold or given to the public:\~l7Lfir.------------------------------------------------------- — <br />I am providing food that is NOT prepared at home: [0,Yes El No <br />All food is prepared on-site oris from approved commercial facilities: 0Yes No <br />Name of facility: FVjf QA Phone: <br />Address of facility: \ C -------LCm |----C <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 />asphalt, clean tarps and smooth wood are acceptable) and-constructed to separate food and food preparation <br />areas from the public. | | . <br /> <br />Pother (specify):VOCQ ^YvJC---------------------------- <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 />Approved water for-drinking, utensil and hand washing will be provided in my booth by the following methods.